CT coronary and myocardial images in patients with coronary artery lesions

Abstract

Coronary computed tomographic angiography (CCTA) is a next-generation modality that can be used instead of coronary catheterization. It can be useful in evaluating coronary artery lesions after Kawasaki disease (KD) if physicians are mindful of its three drawbacks, namely, the use of beta-blockade, use of contrast medium, and exposure to radioactivity. CCTA has potential advantages in comparison with MR coronary angiography, including better spatial resolution, shorter imaging time, easier operation, and better visualization of collateral circulation characteristic to KD. Myocardial perfusion imaging (MPI) using technetium-labeled agents is practical in assessing coronary perfusion in patients with myocardial ischemia or infarction after KD. Both rest and stress imaging are essential for evaluating myocardial ischemia or infarction by means of a 1-day protocol, but a 2-day protocol should be used when evaluating infants with pharmacologic stress. A comprehensive plan is required, including control of body movement, ensuring a sufficient interval (and a high-fat meal) between administration of agents and acquisition, the use of the Monzen position during acquisition, and ensuring the patient consumes soda water immediately before acquisition. The Japanese Society of Nuclear Medicine proposes using pediatric-appropriate doses of nuclear agents. Combined evaluation with CCTA and MPI is the new standard for managing patients with coronary artery lesions after KD.