doi: 10.1161/CIRCULATIONAHA.104.526731
(Circulation. 2005;112:e315-e316.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Detection of Active Coronary Arterial Vasculitis Using Magnetic Resonance Imaging in Kawasaki Disease
From the Lillie Frank Abercrombie Section of Pediatric Cardiology (C.J.M., J.T.S., M.D.T., J.P.K., G.W.V.) and Edward B. Singleton Department of Radiology (R.K., R.M., T.C.), Texas Children’s Hospital and Baylor College of Medicine, Houston, Tex, and Philips Medical Systems (R.M.), Cleveland, Ohio.
Correspondence to G. Wesley Vick, MD, PhD, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas 77030. E-mail gvick{at}bcm.tmc.edu
A 7-kilogram 3-month-old boy was hospitalized with a 5-day history of high fever (>103°F), macular rash, strawberry tongue, and persistent irritability. A diagnosis of Kawasaki disease was made and the patient received 2 doses of intravenous immunoglobulin, prednisone, and high-dose aspirin. His platelet count was significantly elevated to 1.4 million/µL.
Clinical examination revealed mild swelling of his fingertips and a diffuse macular rash. There was cervical and inguinal lymphadenopathy. The precordium was quiet and the first and second heart sounds were normal with no cardiac murmurs. The lungs were clear to auscultation and the abdominal examination was normal. A chest radiograph was normal. ECG demonstrated normal sinus rhythm with non-specific ST-segment changes. Echocardiography at time of admission demonstrated prominent coronary arteries without definite aneurysms. Follow-up echocardiograms over the succeeding 2 weeks demonstrated progression to aneurysmal dilatation in the left and right coronary arteries. The patient underwent cardiac magnetic resonance imagining (MRI) 2 weeks after admission to further delineate the aneurysms. Magnetic resonance images were acquired on the fourteenth day after hospitalization with a commercial MRI scanner (1.5 Tesla NT-Intera, Philips Medical Systems). Detailed imaging of coronary artery morphology was performed with a real-time, fat-suppressed, T2-prepared, navigator technique1,2 (Figure 1) and confirmed the presence of severe coronary artery dilation. The cross section of the left anterior descending coronary artery was imaged using a double inversion recovery black-blood, short-tau inversion recovery sequence (STIR) sequence (often referred to as the triple inversion recovery sequence) with respiratory navigators and cardiac gating to combat the deleterious effects of motion due to cardiac pulsation and respiration. Strikingly high signal intensity was demonstrated in the coronary artery walls with this method (see cross section of left anterior descending coronary artery in Figure 2). Such STIR sequences have been used in other parts of the body to highlight inflammation.3 This high signal intensity on the triple inversion recovery images is consistent with the presence of diffuse active inflammation and edema.
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Although MRI has been shown to compare favorably to conventional x-ray angiography in evaluating coronary arterial origin and proximal course in children and adults with Kawasaki disease,4,5 this report highlights the usefulness of MRI in demonstrating active vasculitic inflammation in the wall of the coronary arteries.
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