All issues > Volume 42(2); 1999

Original Article

J Korean Pediatr Soc. 1999;42(2):211-220. Published online February 15, 1999.

Assessment of Myocardial Ischemia using Myocardial Perfusion Scan in Kawasaki Disease

Hong Ryang HR Gil¹, Jung Yun JY Choi², Myeong Ja MJ Yoon², Soon Seong SS Park², Ho Sung HS Kim², Chung Il CI No², Yong Soo YS Yoon², Myung Chul MC Lee³, Dong Soo DS 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

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.

Keywords :Kawasaki disease, Myocardial SPECT, Myocardial ischemia