Coronary artery evaluation in Kawasaki disease by dual source multi-detector CT coronary angiography in children/Cocuk yasta Kawasaki hastalarinda "dual source" multi detektor BT anjiyografi ile koroner arter degerlendirmesi.

Kawasaki disease is a childhood vasculitis of medium-sized vessels, affecting the coronary arteries in particular. Assessment of the degree of coronary stenosis and serial evaluation of coronary artery pathologies are essential for risk stratification and therapeutic management. Invasive coronary angiography is considered to be the gold standard technique. Multi-detector computed tomography coronary angiography (CTCA) is a noninvasive alternative imaging modality. It can also provide complementary morphologic data to echocardiography.

The CTCA is an approved noninvasive technique in the diagnosis of coronary pathologies. Dual source CTCA is a new generation device that can acquire diagnostic images in patients with high heart rates and/or arrhythmias without the use of beta blockers. This is advantageous for pediatric patients whose heart rates are generally higher than the average adult groups.

A 4-year old boy with 7 months' history of Kawasaki disease was admitted to the hospital for CTCA. In the previous echocardiographic examination 2 coronary aneurysms were detected in left main coronary artery (LMCA) and right coronary artery (RCA).

The CTCA was performed with a dual source (2x64 detector system) CT scanner during free breathing and injection of 40 mL of intravenous contrast material. The average heart rate during the scan was 95 beats/min. No beta blocker was administered. Multiplanar reconstruction images showed three aneurysms; one in the distal LMCA, one in the middistal left anterior descending artery and the other one in the mid RCA (Fig. 1-4, Video 1. See corresponding video/movie images at www.anakarder.com). There was a striking fibrointimal proliferation in the RCA aneurysm causing luminal stenosis (Fig. 1, 2 ). No pericardial, myocardial or endocardial pathology was detected.

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Serkan Gelmez, Arda Saygili *, Ercan Tutar **, Muzaffer Olcay Cizmeli

From Departments of Radiology and * Pediatric Cardiology, Acibadem Hospital, Istanbul

** Department of Pediatric Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey

Address for Correspondence/Yazisma Adresi: Dr. Serkan Gelmez Tekin Sok. No 111 Kadikoy Istanbul, Turkey Phone: [phone] Mobile: + 90 542 288 40 27 E-mail: [e-mail]