Abstract 178: Measurements of coronary aneurysms due to Kawasaki Disease by Dual-Source Computed Tomography (DSCT)

Background: Diameters of coronary artery aneurysms (CAAs) due to KD in the acute phase can strongly predict long-term prognosis of coronary artery lesions. Recently, Computed Tomography Angiography (CTA) has been used in the diagnosis of coronary artery lesion (CAL). Purpose: The purpose of this study was to determine whether measurements of coronary artery diameters by CTA using DSCT can be used instead of coronary angiograms (CAG) during cardiac catheterization. Methods: Twenty five pts (22 males and 3 females) with CAL due to KD were evaluated. Their ages ranged from 5 months to 38 years (median 11years). CTA was performed between July 2007 and July 2013, and CAG was done within one year. A prospective Electrocardiogram (ECG) -triggered CTA was performed on a DSCT (SOMATOM® Definition (from July 2007 to October 2009) or SOMATOM® Definition Flash (from October 2009 to July 2013); Siemens Healthcare, Germany). ECG-gated scans were performed in 19 cases and Flash Spiral scans in 6 cases. Two pediatric cardiologists measured the diameters of CAAs twice in each maximum intensity projection (MIP), curved multi planer reconstruction (MPR) and CAG. We measured 161 segments in total (segment1-3,5-7,11,13). Diagnostic accuracy was expressed as κ coefficient. A Bland-Altman analysis was also used to assess the inter-observer, intra-observer and inter-material agreement. Results: The visualization capability of coronary arteries was excellent. One segment was not visualized by CTA. Detection rate in CTA, comparing with CAG, was 99.7%, and the diagnostic quality of CTA was excellent (κ=0.93). Excellent inter-observer agreement for diameters of CAAs was obtained for MIP, MPR and CAG and for the intra-observer agreement. The inter-modality agreement was also excellent (MPR-CAG : y=0.9x+0.40, r=0.97 ,p<0.01 MIP-CAG : y=1.0x+0.1, r=0.94, p<0.01). We also studied the diameters in normal segments. We also obtained good correlation between inter-observer, intra-observer and inter-modality (MPR-CAG : y=1.0x, r=0.89 , p<0.01 MIP-CAG : y=1.0x+0.1, r=0.88, p<0.01). Conclusion: We found a significant good correlation in the measurements of coronary artery between CTA and CAG. Measurement of the diameters of coronary artery by CTA is reliable and useful.