Coronary Aneurysms in Kawasaki’s Disease Detected by Magnetic Resonance Coronary Angiography
A20-year-old woman with a history of Kawasaki’s disease as a child and coronary aneurysms underwent cardiac MRI for reevaluation before an intended pregnancy. The patient regularly participated in athletic activities, and the physical examination was unremarkable. The ECG showed normal sinus rhythm and nonspecific T-wave abnormalities in the precordial leads. MRI (1.5-T ACS-NT, Philips Medical Systems) revealed normal left ventricular size and function. During an exercise stress test performed at the scanner with an MRI-compatible ergometer, the patient achieved 90% maximal predicted heart rate with no segmental wall abnormalities at peak exercise. ECG-triggered and navigator-gated and -corrected 3D coronary MR angiography was performed, demonstrating aneurysms of both the left and right coronary arteries (Figure 1⇓). A turbo-field echo pulse sequence incorporating a T2 preparation pulse to enhance blood-myocardium contrast was used.1 Images were acquired over multiple heartbeats with a 63-ms acquisition window in middiastole. Separate oblique data sets were acquired for the left and right coronary arteries. Both the right coronary artery and the left anterior descending coronary artery (LAD) could be clearly delineated up to 5.5 cm from their origin. Multiplanar reformats show a large aneurysm, 14×16×11 mm in diameter, of the proximal LAD at the junction of the left main, LAD, and left circumflex coronary arteries and a smaller aneurysm, 6 mm in diameter, in the proximal right coronary artery (Figures 2⇓ and 3⇓).
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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