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Assessment of Myocardial Ischemia using Myocardial Perfusion Scan in Kawasaki Disease

Journal of the Korean Pediatric Society 1999;42(2):211-220.
Published online February 15, 1999.
Assessment of Myocardial Ischemia using Myocardial Perfusion Scan in Kawasaki Disease
Hong Ryang Gil1, Jung Yun Choi2, Myeong Ja Yoon2, Soon Seong Park2, Ho Sung Kim2, Chung Il No2, Yong Soo Yoon2, Myung Chul Lee3, Dong Soo Lee3
1Department of Pediatrics, College of Medicine†, Chungnam National University, Daejeon, Korea
2Department of Pediatrics, College of Medicine, Seoul National University, Seoul , Korea
3Department of Pediatrics, Nuclear Medicine, College of Medicine, Seoul National University, Seoul , Korea
가와사끼병에서 Myocardial SPECT를 이용한 심근허혈의 평가
길홍량1, 최정연2, 윤명자2, 박순성2, 김호성2, 노정일2, 윤용수2, 이명철3, 이동수3
1충남대학교 의과대학 소아과학교실
2서울대학교 의과대학 소아과학교실
3서울대학교 의과대학 핵의학교실
Abstract
Purpose
: Myocardial scintigraphy has been reported to be useful in adults, but its usefulness in children is limited. This study was done to determine the feasibility and accuracy of 99mTc-MIBI SPECT(sestamibi, methoxy-isobutyl-isonitrarite myocardial single emission computed tomography, Dp-SPECT) after dipyridamole infusion to detect coronary obstructive lesions in Kawasaki disease (KD).
Methods
: Dp-SPECT was performed in 21 control(group 1), 8 with coronary aneurysm(group 2) and 16 with coronary obstructive lesion(group 3) in children with KD. The spatial distribution of Dp-SPECT was determined and analyzed visually. Group 2 and 3 underwent coronary angiogram within 3 months of Dp-SPECT.
Results
: Chest pain occurred more frequently in group 2. No subject required supplemental oxygen or were complicated by myocardial ischemia. The specificity of Dp-SPECT for control subject was 95% & 62% if using a cut-off criterion of abnormality, utilizing moderate or mild perfusion defect, respectively. The false positive rate was high in anterior, apical and anteroseptal segments but not related to age. The abnormalities found on Dp-SPECT was observed in 25% of aneurysmal coronary arteries but not related to its size. The sensitivity, specificity, and accuracy of Dp-SPECT was 100%, 84.5% and 79% in coronary stenosis greater than 75%, respectively.
Conclusion
: The interpretation of Dp-SPECT should be careful in KD because of discrepancies between Dp-SPECT & angiography. But Dp-SPECT is noninvasive and easily applicable. It monitors the occurrence and progression of coronary stenosis due to KD. Besides Dp-SPECT may be applicable after arterial switch operation or to myocardial sinusoid.
Key Words: Kawasaki disease, Myocardial SPECT, Myocardial ischemia


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