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Gui Y, Lin Y, Wu H, Dai G, Liang X, Chu C, Zheng Y, Zhao Q, Wang F, Sun S, Huang G, Yan W, He L, Liu F. Diagnostic Value of 99mTc-MIBI Myocardial Perfusion Imaging in Detecting Myocardial Ischemia of Children with Kawasaki Disease and Coronary Artery Lesions. Pediatr Cardiol 2024:10.1007/s00246-024-03545-2. [PMID: 38940825 DOI: 10.1007/s00246-024-03545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/07/2024] [Indexed: 06/29/2024]
Abstract
Pediatric patients with coronary artery lesions (CALs) after Kawasaki disease (KD) may be complicated with myocardial ischemia. Although previous studies in adults have proven the diagnostic value of 99mTc-MIBI myocardial perfusion imaging (MPI) for ischemic heart disease, its feasibility and accuracy in this pediatric population remain uncertain. In this retrospective study, we collected data of 177 pediatric patients (Age range: 6 months to 14 years) who had undergone MPI and coronary artery angiography (CAG) between July 2019 and February 2023. Using the positive result of CAG as the reference standard of myocardial ischemia, we compared the results of 99mTc-MIBI MPI with other non-invasive examinations, including cardiac magnetic resonance imaging (CMRI), echocardiogram, and comprehensive electrocardiogram-related examinations. All patients finished adenosine triphosphate stress MPI without major side effects. The sensitivity of MPI was 79.17%, which was greater than CMRI and echocardiogram (P < 0.05). The negative predictive value and the accuracy of MPI were 89.9% and 71.75%, indicating the advantages over others. Composite monitoring strategy of MPI and CMRI effectively improved the diagnostic performance (P < 0.001). In 4 cases diagnosed with myocardial ischemia by "MPI + CMRI," despite the absence of significant stenosis, multiple giant coronary artery aneurysms (GCAA) were all observed in CAG. 99mTc-MIBI MPI is the preferred non-invasive examination for detecting myocardial ischemia in pediatric patients with CAL after KD. When combined with CMRI, it can enhance diagnostic accuracy. Multiple GCAAs without stenosis may be an isolated risk factor of myocardial ischemia.
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Affiliation(s)
- Yiting Gui
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yixiang Lin
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Ha Wu
- Nuclear Medicine Department, Children's Hospital of Fudan University, Shanghai, China
| | - Guangan Dai
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xuecun Liang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Chen Chu
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanzheng Zheng
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Quming Zhao
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Feng Wang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Shuna Sun
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guoying Huang
- Heart Center, Children's Hospital of Fudan University, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology and Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Lan He
- Heart Center, Children's Hospital of Fudan University, Shanghai, China.
| | - Fang Liu
- Heart Center, Children's Hospital of Fudan University, Shanghai, China.
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Donuru A, Parekh M, Kandula VVR, Gould S. Coronary artery aneurysm in Kawasaki disease. Ann Pediatr Cardiol 2020; 13:267-268. [PMID: 32863669 PMCID: PMC7437614 DOI: 10.4103/apc.apc_6_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
A 3-year-old male presents to the emergency department with chief complaints of fever and vomiting. He had a positive rapid streptococcus throat test with cervical lymphadenopathy. The patient was started on antibiotics. On examination, there was diffuse erythematous macular rash on the chest. Laboratory tests revealed elevated white cell count and C-reactive protein. Electrocardiogram was notable for prolonged PR interval indicating 1st degree atrioventricular block. Echocardiogram revealed ectasia of the right coronary artery (RCA). A presumptive diagnosis of Kawasaki disease was made and the patient was started on high-dose aspirin and intravenous immunoglobulins. Cardiac computed tomography angiography (CTA) showed an aneurysm of the proximal RCA measuring up to 7.4 mm. The RCA immediately proximal to the aneurysm measured 3 mm in diameter. The Z score was 13.4. Oblique coronal image from cardiac CTA and volume rendered images demonstrated an aneurysm of the proximal RCA. The patient improved with treatment.
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Affiliation(s)
- Achala Donuru
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA 19107, USA
| | - Maansi Parekh
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA 19107, USA
| | | | - Sharon Gould
- Department of Medical Imaging, Wilmington, DE 19803, USA
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