Adolescent Kawasaki disease: Usefulness of 64-slice CT coronary angiography for follow-up investigation

Background: Kawasaki disease (KD) is a systemic vasculitis that mainly affects coronary arteries in children, and requires regular follow-up from the time of diagnosis. Objective: To evaluate the feasibility of 64-slice CT angiography (CTA) for follow-up of patients with KD using previously performed invasive catheter coronary angiography (CCA) as reference standard. Materials and methods: The study group comprised 12 patients (age 17.6±2.9 years, mean±SD) with a diagnosis of KD and a previously performed CCA (interval, 32.6±13.5 months) who underwent 64-slice cardiac CTA. The quality of the images for establishing the presence of coronary abnormalities was determined by two observers. The CTA findings were compared with those from the prior CCA. Results: Adequate image quality was obtained in all patients. Mean effective dose for CTA was 6.56±0.95 mSv. CTA allowed accurate identification, characterization and measurement of all coronary aneurysms (n=32), stenoses (n=3) and occlusions (n=9) previously demonstrated by CCA. One patient with disease progression went on to have percutaneous coronary intervention. Conclusion: Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures.