Coronary vessel wall assessment after Kawasaki Disease
© Hussain et al; licensee BioMed Central Ltd. 2011
Published: 2 February 2011
2D cross-sectional Dual-Inversion-Recovery (DIR) black-blood imaging of the coronary arteries has been used to assess Kawasaki Disease (KD) (Greil et al. 2007). A 3D coronary black-blood approach, however, has been shown to provide better coverage of the coronary tree (Botnar et al 2001). Furthermore, uptake of gadolinium contrast agent in coronary walls may indicate on-going inflammation or vessel wall fibrosis (Maintz et al, 2006).
To investigate whether in-plane 3D coronary vessel wall imaging utilizing a local-inversion technique and spiral image acquisition, in combination with contrast-enhanced inversion-recovery (IR) imaging allows more comprehensive assessment of KD.
Patients with previous coronary aneurysms due to KD undergoing routine CMR evaluation had additional vessel wall imaging before and after contrast administration (0.2 mmol/kg gadopentetate dimeglumine). All examinations were performed on a 1.5T MR-system and the coil was selected according to patient size (two-element/five-element). Coronary MRA was followed by a targeted, free-breathing, ECG-triggered 3D vessel wall sequence using local inversion and spiral image acquisition (spatial resolution=0.76x0.76x2mm; TE/TR=2/29ms, FA=90°). Areas of vessel wall thickening on in-plane imaging were then further evaluated with through plane 2D DIR vessel wall technique.
Post-contrast imaging was performed using a free-breathing, ECG-triggered, 3D IR segmented gradient-echo (TFE) sequence (spatial resolution=1.25x1.25x3mm, TE/TR=1.4/3.5ms, FA=30° & TI chosen to null blood using Look-Locker).
Our data suggests that inflammation of the coronary vessel wall in Kawasaki disease may persist for up to 2 years post-acute insult. Vessel wall remodeling seems to have occurred effectively in the resolved aneurysms studied here. 3D in-plane local-inversion black-blood imaging gives more complete coverage of affected segments and allows targeting of cross-sectional imaging of thickened areas. The protocol outlined here gives a more comprehensive assessment of affected coronaries after KD.
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