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Evaluating for systemic artery aneurysms using noncontrast magnetic resonance angiography in patients with Kawasaki disease: A report of two cases

ABSTRACT: Kawasaki disease (KD) involves coronary aneurysms and can infrequently cause systemic artery aneurysms (SAAs). Therefore, patients with KD should be evaluated for both coronary and systemic arterial aneurysms. This report describes 2 cases of SAA evaluated using the diastolic phase image of electrocardiogram-gated three-dimensional fast spin echo during noncontrast magnetic resonance angiography. The first case was a 1-year-old male who diagnosed with KD at 2 months of age. Multiple right axillary artery aneurysms measuring 6.0 mm and 2.5 mm and left axillary artery aneurysms measuring 12.0 mm, 4.0 mm, and 3.0 mm were observed by scanning for 94 seconds. The second case was a 13-year-old male who diagnosed with KD at 4 months of age, with a 7.0-mm right axillary artery aneurysm observed by scanning for 101 seconds. Electrocardiogram-gated three-dimensional fast spin echo in the diastolic phase can help evaluate SAA in patients with KD and does not require a prolonged scanning time or contrast medium.

SUBMITTER: Nonaka H

PROVIDER: S-EPMC7785888 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Project description:Kawasaki Disease (KD) is the leading cause of acquired pediatric heart disease. A subset of KD patients develops aneurysms in the coronary arteries, leading to increased risk of thrombosis and myocardial infarction. Currently, there are limited clinical data to guide the management of these patients, and the hemodynamic effects of these aneurysms are unknown. We applied patient-specific modeling to systematically quantify hemodynamics and wall shear stress in coronary arteries with aneurysms caused by KD. We modeled the hemodynamics in the aneurysms using anatomic data obtained by multi-detector computed tomography (CT) in a 10-year-old male subject who suffered KD at age 3 years. The altered hemodynamics were compared to that of a reconstructed normal coronary anatomy using our subject as the model. Computer simulations using a robust finite element framework were used to quantify time-varying shear stresses and particle trajectories in the coronary arteries. We accounted for the cardiac contractility and the microcirculation using physiologic downstream boundary conditions. The presence of aneurysms in the proximal coronary artery leads to flow recirculation, reduced wall shear stress within the aneurysm, and high wall shear stress gradients at the neck of the aneurysm. The wall shear stress in the KD subject (2.95-3.81 dynes/sq cm) was an order of magnitude lower than the normal control model (17.10-27.15 dynes/sq cm). Particle residence times were significantly higher, taking 5 cardiac cycles to fully clear from the aneurysmal regions in the KD subject compared to only 1.3 cardiac cycles from the corresponding regions of the normal model. In this novel quantitative study of hemodynamics in coronary aneurysms caused by KD, we documented markedly abnormal flow patterns that are associated with increased risk of thrombosis. This methodology has the potential to provide further insights into the effects of aneurysms in KD and to help risk stratify patients for appropriate medical and surgical interventions.

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Evaluating for systemic artery aneurysms using noncontrast magnetic resonance angiography in patients with Kawasaki disease: A report of two cases

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