1350470 - Long-term coronary artery evaluation in patients with Kawasaki disease using non-contrast magnetic resonance angiography

Kawasaki disease (KD) is a systemic vasculitis, especially known to form coronary artery aneurysms (CAA). CAA may require long-term follow-up because occlusion due to thrombosis and cause progressive stenosis from active remodeling with intimal proliferation and neoangiogenesis. Non-contrast magnetic resonance angiography (NC-MRA) is a valuable modality for evaluating coronary arteries in patients with KD, but its long-term follow-up has not been clarified. This study aimed to investigate the usefulness of NC-MRA for long-term follow-up of patients with KD.

Methods:

All examinations were performed on a 1.5 tesla MRI system and two scanners. (Intera Achieva, Philips Healthcare, Best, Netherlands, or Ingenia, Philips Healthcare, Best, Netherlands). One hundred twenty-three patients who underwent non-contrast coronary MRA in our Hospital between October 2005 and September 2022, 39 patients (75 aneurysms) were identified who had more than five years have passed since the onset and performed MRA at least twice during the period. Patients were classified into three groups according to the diameter of coronary aneurysms in the acute phase. （Large (n=19): 10≦ Z score or diameter 8mm ≦, Medium (n=42): 5.0≦Z score＜10 and diameter ＜ 8mm, Small (n=14): Z score ＜5.0）. A single radiologist visually assessed the presence of stenosis and defined stenosis as 25% or greater. Stenotic lesions were contrasted with angiography (AG) or computed tomography angiography (CTA). The Kaplan-Meier curve was used to determine the incidence of stenotic lesions at 10, 15, and 20 years after onset.

Results:

Coronary artery stenosis was observed in 14 patients (17 lesions); all 16 lesions were consistent with AG or CTA except one lesion for which no additional examination was performed. The stenosis rate in the large group was 27.0% at ten years, 48.4% at 15 years, and 64.6% at 20 years; in the medium group was 7.6% at ten years, 11.8% at 15 years, and 31.3% at 20 years; in the small group was not observed stenotic lesion.

Conclusion:

Evaluation of coronary artery stenosis in patient with KD using NC-MRA was almost coincides with the evaluation of AG and CTA. The stenosis rate at 20 years after onset was similar to previous studies using AG[1] and ultrasound[2]; it was suggested that long-term evaluation is possible.