Pediatric Rheumatology Online Journal → July 2003 → Vasculitides → Kawasaki Disease → Abstract #129

IMAGING OF CORONARY AND PERIPHERAL ARTERIES WITH MAGNETIC RESONANCE ANGIOGRAPHY (MRA) IN INFANTS WITH KAWASAKI DISEASE: A NEW UTILIZATION TO GUIDE THERAPY

B. L. Myones,¹ C. A. Altman,¹ N. Ayres,¹ R. M. Braverman,¹ M. M. DeGuzman,¹ S. W. Denfield,¹ N. J. Kertesz,¹ G. C. Kung,¹ M. D. Perez,¹ G. W. Vick III,¹ R. W. Warren,¹ T. Chung.¹

Rheumatology, Cardiology, and Diagnostic Imaging, Texas Childrens Hospital and Baylor College of Medicine, Houston, TX

Echocardiography (ECHO) is the standard modality used to image the occurrence and course of coronary artery aneurysms (CAA) and giant coronary aneurysms (GCA) in Kawasaki Disease (KD). Sonography is not usually performed on other arteries, unless there is evidence on physical exam of peripheral aneurysm formation (which may also be discovered incidentally at cardiac catheterization). Peripheral aneurysms were identified on physical exam in 5 infants with KD (aged 3-9 months). In order to define the extent of peripheral arterial involvement, these clinically unstable infants underwent magnetic resonance angiography (MRA) of the torso including the coronary arteries with a clinical MR 1.5T scanner. Time-resolved contrast-enhanced whole body MRA (CE-MRA) with SENSE acceleration technique and non-contrast coronary 3D-MRA with respiratory navigator technique were performed. Results of coronary MRA were compared with ECHO. All 5 infants had multiple arterial aneurysms of the torso and limbs, only a few of which were detected clinically. Coronary MRA revealed CAA/GCA in all infants and correlated with ECHO results. All 5 infants were treated with IVIG and subsequently with IV pulse steroids because of persistent symptoms, unstable hemodynamics and the age at presentation. LMW-heparin and oral pentoxifylline were added due to severity of coronary lesions and the presence of peripheral arterial disease. Serial MRAs performed in 3 infants showed partial regression of peripheral aneurysms/CAA/GCA. In this study, MRA was used successfully as a sensitive, non-invasive imaging modality to evaluate infants with KD . Whole body MRA yielded clinically relevant information, especially regarding response to treatment and subsequent course of peripheral vascular lesions, that helped to guide more aggressive therapy with steroids, anticoagulants, and antiplatelet/vasodilator drugs.