title: Cardiac magnetic resonance imaging for noninvasive assessment of cardiovascular disease during the follow-up of patients with Kawasaki disease.
abstract: BACKGROUND
  Kawasaki disease (KD) is the most common cause of acquired coronary artery disease in childhood. In KD, the American Heart Association recommends echocardiography for routine coronary artery surveillance and nuclear perfusion scans and conventional coronary angiography in select patients. Cardiac MRI (CMRI) may be a noninvasive and radiation-free alternative. We applied CMRI during the follow-up of patients with KD and assessed the performance of CMRI compared with echocardiography.
  
  
  RESULTS
  Patients with KD aged ≥8 years were consecutively included. Sixty-three patients (median age, 14.6 years; 74.6% male sex) underwent a comprehensive CMRI protocol including adenosine stress testing to evaluate coronary artery anatomy, ischemia, and myocardial infarction. All patients underwent CMRI without significant complications. On CMRI, 23 coronary artery aneurysms (CAAs) were identified in 15 patients. CMRI detected thrombus formation in 6 CAAs in 4 patients, wall motion disturbances and ischemia in 4 patients, and delayed hyperenhancement indicating myocardial infarction in 5 patients. Wall motion and perfusion abnormalities were noted in territories supplied by affected coronary arteries. CMRI results were compared with recent echocardiography findings. In 6 of the 15 patients with CAAs on CMRI, CAAs were not detected by echocardiography.
  
  
  CONCLUSIONS
  A comprehensive CMRI protocol including adenosine stress testing is feasible to identify coronary artery pathology, ischemia, and myocardial infarction in former patients with KD and compares favorably with echocardiography. CMRI may be used as a noninvasive and radiation-free imaging method for coronary artery surveillance during the long-term follow-up of patients with KD.
authors.affiliation: Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands. c.e.tacke@amc.uva.nl
authors.forename: Carline E
authors.initials: CE
authors.lastname: Tacke
authors.forename: Irene M
authors.initials: IM
authors.lastname: Kuipers
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.forename: Anje M
authors.initials: AM
authors.lastname: Spijkerboer
authors.forename: Taco W
authors.initials: TW
authors.lastname: Kuijpers
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D015150:Echocardiography, Doppler / Q000379:methods; D025401:Echocardiography, Stress; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D014481:United States