title: Stress perfusion magnetic resonance imaging to detect coronary artery lesions in children.
abstract: BACKGROUND
  Stress perfusion cardiovascular magnetic resonance (CMR) is used widely in adult ischemic heart disease, but data in children is limited. We sought to evaluate feasibility, accuracy and prognostic value of stress CMR in children with suspected coronary artery disease (CAD).
  
  
  METHODS
  Stress CMR was reviewed from two pediatric centers over 5 years using a standard pharmacologic protocol. Wall motion abnormalities, perfusion deficits and late enhancement were correlated with coronary angiogram (CAG) when available, and clinical status at 1 year follow-up for major adverse cardiovascular events (MACE; coronary revascularization, non-fatal myocardial infarction and death due to CAD) was recorded.
  
  
  RESULTS
  Sixty-four stress perfusion CMR studies in 48 children (10.9 ± 4.8 years) using adenosine; 59 (92%) and dipyridamole; 5 (8%), were reviewed. Indications were Kawasaki disease (39%), post arterial switch operation (12.5%), post heart transplantation (12.5%), post anomalous coronary artery repair (11%), chest pain (11%), suspected myocarditis or CAD (3%), post coronary revascularization (3%), and others (8%). Twenty-six studies were performed under sedation. Of all studies performed, 66% showed no evidence of ischemia or infarction, 28% had perfusion deficits and 6% had late gadolinium enhancement (LGE) without perfusion deficit. Compared to CAG, the positive predictive value (PPV) of stress CMR was 80% with negative predictive value (NPV) of 88%. At 1 year clinical follow-up, the PPV and NPV of stress CMR to predict MACE were 78 and 98%.
  
  
  CONCLUSIONS
  Stress-perfusion CMR, in combination with LGE and wall motion-analysis is a feasible and an accurate method of diagnosing CAD in children. In difficult cases, it also helps guide clinical intervention by complementing conventional CAG with functional information.
authors.affiliation: Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. cvijarnsorn@yahoo.com.|Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. cvijarnsorn@yahoo.com.
authors.forename: Chodchanok
authors.initials: C
authors.lastname: Vijarnsorn
authors.affiliation: Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Noga
authors.affiliation: Variety Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Daryl
authors.initials: D
authors.lastname: Schantz
authors.affiliation: Variety Children's Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Dion
authors.initials: D
authors.lastname: Pepelassis
authors.affiliation: Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Edythe B
authors.initials: EB
authors.lastname: Tham
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000416:Alberta; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013785:Thailand
chemical_list: D003287:Contrast Media
keywords: Cardiovascular magnetic resonance; Children; Stress myocardial perfusion imaging