1357014 - Myocardial ischemia caused by multiple giant coronary aneurysms following Kawasaki disease evaluated using fully automated quantitative stress-CMR perfusion imaging.

Perfusion CMR-scan (December 2022) was performed after pharmacological provocation with Regadenosone and at rest, after reversal of Regadenosone effect with Theophyllamine, using pre-bolus, single sequence technique. AI-based software cvi42 was used for automated calculation of myocardial blood flow at baseline (rest MBF), during vasodilation (stress MBF), and myocardial perfusion reserve (MPR), at segmental, coronary territory, and global level.

During the study an adequate hemodynamic response was achieved. No chest pain and no arrhythmia during provocation was observed. First passage stress images showed reduced perfusion in the basal and midventricular infero-septal segment, and a normal perfusion at rest.

Automated quantification revealed relatively high rest MBF, probably stress-depended, globally 2.5 mL/g/min. Stress MBF raised to 3.1 mL/g/min. Regionally, reduced perfusion (defined as stress MBF < 2.0ml/g/min) was limited only to one basal infero-septal segment, 1.8 ml/g/min.


Dixon-sequence confirmed multiple coronary aneurysms of max diameter of 20 mm. The dimensions of all four chambers were normal with preserved both left and right ventricular function. Left ventricle: EDV 94 ml, 75 ml/m² (normal range 55-95), EF 70%, GLS -19.9%, no regional hypo/dyskinesia. No late gadolinium enhancement. Calculated left ventricular mass was increased to 143g, 91g/m² (normal range 35-71).

Learning Points from this Case: This case illustrates that fully automated quantitative stress-CMR perfusion imaging is an ultimate radiation-free option for a serial scanning of pediatric patients with severe coronary engagement in course of Kawasaki disease, providing both anatomical and reliable physiological information, especially in case of emerging balanced ischemia due to three-vessel disease, where rMPI imaging has limited value.