Study: Chest x-ray IDs Kawasaki disease patients at risk for stenosis
Chest x-ray easily identifies Kawasaki disease patients at risk for serious coronary artery stenosis when a specific search for coronary artery calcification is pursued, according to a study in this month's Pediatric Cardiology.
Chantale Lapierre, MD, from the department of medical imaging at the University of Montreal, Sainte-Justine Hospital in Montreal, and colleagues retrospectively studied 65 coronary angiograms performed on 50 Kawasaki disease patients (35 males). The exams were performed due to persistent coronary lesions on echocardiography from most of the patients, and for non specific chest pain for other patients.
The mean age at the time of diagnosis of Kawasaki disease was 4.8 years, and 9.5 years at the time of their first coronary angiogram, with an interval time of 5.1 years.The authors said their objective was to correlate the angiographic anomalies associated with coronary calcifications in Kawasaki disease found on chest x-ray and evaluate the chronology and detection rate.
Angiograms were normal in 32 patients and coronary artery lesions were identified in 18, according to the authors. Of the 18 patients with significant finds, the reported lesions included isolated coronary artery aneurysms in 10 patients (five solitary and five multiple aneurysms) and aneurysms associated with obstructed lesions in the other eight. All 18 patients had their chest x-rays reviewed.
All obstructive lesions were concomitant with calcification but one. In five of eight patients with coronary artery calcification and obstruction lesions, calcifications were located in one of the lesions and there was an additional coronary obstructive lesion without calcification. According to the authors, the time interval between the onset of the disease and the diagnosis of obstructive coronary artery lesions was 5.6 years.
All calcification sites were identified both on fluoroscopy and chest x-ray, with 100 percent agreement between the two techniques, Lapierre and colleagues reported. The calcification along the left coronary artery was more visible on the posterioanterior view and for the right coronary artery calcification both posterioanterior and lateral views were useful in the chest x-ray exams conducted on all 50 patients.
Also, they found that there was 100 percent agreement among radiologists interpreting the chest x-rays with respect to the presence or absence of coronary artery calcification and the location of the calcifications.
According to the authors, their data demonstrates a chronological relationship between the onset of coronary artery calcification and advanced coronary artery obstructive lesions.
"Micro-calcificiations appear to indicate severe coronary artery lesions,” Lapierre and colleagues wrote, “in our experience a yearly chest x-ray specifically looking for coronary artery calcifications may well be indicated for patients with Kawasaki disease with persistent coronary aneurysm.”
And when calcifications are detected, the reserachers said, evaluations should be completed via other imaging techniques such as selective angiography, multislice CT or cardiac MRI.
Chantale Lapierre, MD, from the department of medical imaging at the University of Montreal, Sainte-Justine Hospital in Montreal, and colleagues retrospectively studied 65 coronary angiograms performed on 50 Kawasaki disease patients (35 males). The exams were performed due to persistent coronary lesions on echocardiography from most of the patients, and for non specific chest pain for other patients.
The mean age at the time of diagnosis of Kawasaki disease was 4.8 years, and 9.5 years at the time of their first coronary angiogram, with an interval time of 5.1 years.The authors said their objective was to correlate the angiographic anomalies associated with coronary calcifications in Kawasaki disease found on chest x-ray and evaluate the chronology and detection rate.
Angiograms were normal in 32 patients and coronary artery lesions were identified in 18, according to the authors. Of the 18 patients with significant finds, the reported lesions included isolated coronary artery aneurysms in 10 patients (five solitary and five multiple aneurysms) and aneurysms associated with obstructed lesions in the other eight. All 18 patients had their chest x-rays reviewed.
All obstructive lesions were concomitant with calcification but one. In five of eight patients with coronary artery calcification and obstruction lesions, calcifications were located in one of the lesions and there was an additional coronary obstructive lesion without calcification. According to the authors, the time interval between the onset of the disease and the diagnosis of obstructive coronary artery lesions was 5.6 years.
All calcification sites were identified both on fluoroscopy and chest x-ray, with 100 percent agreement between the two techniques, Lapierre and colleagues reported. The calcification along the left coronary artery was more visible on the posterioanterior view and for the right coronary artery calcification both posterioanterior and lateral views were useful in the chest x-ray exams conducted on all 50 patients.
Also, they found that there was 100 percent agreement among radiologists interpreting the chest x-rays with respect to the presence or absence of coronary artery calcification and the location of the calcifications.
According to the authors, their data demonstrates a chronological relationship between the onset of coronary artery calcification and advanced coronary artery obstructive lesions.
"Micro-calcificiations appear to indicate severe coronary artery lesions,” Lapierre and colleagues wrote, “in our experience a yearly chest x-ray specifically looking for coronary artery calcifications may well be indicated for patients with Kawasaki disease with persistent coronary aneurysm.”
And when calcifications are detected, the reserachers said, evaluations should be completed via other imaging techniques such as selective angiography, multislice CT or cardiac MRI.