Abstract 220: Magnetic Resonance Imaging in Children with Cardiac Complications of Kawasaki Disease

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Background: MRI is a potentially sensitive, specific, and non-invasive imaging modality that may be used in the detection and monitoring of KD cardiac complications. Its utility relative to the more commonly used imaging modalities of echocardiography and conventional coronary angiography has not been optimally established.

Methods: We compared concomitant clinical data, echocardiography, MRI, and angiography findings for children with coronary artery aneurysms.

Results: MRI and angiograms were performed within 1 month of each other for 15 patients (mean age 7 years, 80% male) at a mean of 4.2 years after diagnosis. Coronary artery bypass grafting (CABG) had been performed in 8 patients (53%). For 7 patients (47%), aneurysms were seen on MRI that were not seen on echocardiography. Wall motion abnormalities were reported in 7 subjects (47%). These were characterized on both echocardiography and MRI for all. MRI identified perfusion defects in 6 patients (40%) and evidence of myocardial scar in 9 patients (60%). Extra-cardiac aneurysms were identified in 5 patients (33%) on MRI. MRI showed strong correlation with angiograms regarding aneurysm location. MRI was limited in the assessment of bypass grafts in 4 of the 8 (50%) patients who had undergone CABG. Three patients (20%) had stenosis or thrombosis identified on angiography that were not appreciated on MRI. Angiograms provided added information regarding flow, stenoses, vascular morphology and/or calcification in 8 patients (53%). Collateral artery anatomy that was not appreciated on echo and MRI were reported on angiograms in 3 patients (20%).

Conclusions: MRI provides a valuable and comprehensive assessment of the cardiac sequelae of KD, though is limited in its assessment of CABG, stenoses, and thrombosis. MRI may be an important component of non-invasive imaging surveillance of children with important coronary artery involvement.

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