Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
J Formos Med Assoc. 2017 Oct;116(10):806-814. doi: 10.1016/j.jfma.2017.07.001. Epub 2017 Jul 19.
BACKGROUND/PURPOSE: The study evaluated possible factors influencing the regression of coronary artery aneurysm (CAA) in patients with Kawasaki disease (KD) through electrocardiographically gated cardiac computed tomography (CT).
18 patients with KD exhibited CAAs in at least 2 CT examinations conducted from December 2004 to September 2015, and 37 aneurysms were observed. Every aneurysm was corrected through the descending aorta at the origin level of the left main coronary artery under a normal distribution and measured under a fixed window level. These aneurysms were divided into 2 groups according to regression. Clinical symptoms, laboratory data, and imaging characteristics of both groups were analyzed.
All the aneurysms of 4 patients decreased in size, and totally, 14 aneurysms (37%) regressed. CAA regression tends to occur early after disease onset. No significant differences were observed in sex, aneurysm location, and the distance to the orifice between the 2 groups. The aneurysms with no calcification (p = 0.012), smaller diameter (p = 0.004), younger disease onset age (p = 0.048), and ectatic shape (p < 0.001) were more likely to regress according to univariate analysis. Receiver operating characteristic analysis revealed that the possible cut-off point of the maximal diameter to yield the highest sensitivity (91.3%) and specificity (92.9%) to predict CAA regression was 5.6 mm.
Calcified CAAs in patients with KD was less likely to regress. The aneurysm size and shape as well as disease onset age were possible factors influencing regression.
背景/目的：本研究通过心电图门控心脏计算机断层扫描（CT）评估影响川崎病（KD）患者冠状动脉瘤（CAA）消退的可能因素。
2004 年 12 月至 2015 年 9 月，18 例 KD 患者至少进行了 2 次 CT 检查，发现至少有 2 个 CAA，共观察到 37 个动脉瘤。每个动脉瘤均在左主干冠状动脉起源水平的降主动脉下通过正态分布进行校正，并在固定窗位下进行测量。根据消退情况将这些动脉瘤分为两组。分析两组的临床症状、实验室数据和影像学特征。
4 例患者的所有动脉瘤均缩小，共 14 个动脉瘤（37%）消退。CAA 消退倾向于在发病后早期发生。两组间性别、动脉瘤位置和与开口距离无显著差异。无钙化（p=0.012）、直径较小（p=0.004）、发病年龄较小（p=0.048）和囊状扩张（p<0.001）的动脉瘤更容易消退。单因素分析显示，最大直径可能的截断值为 5.6mm 时，对 CAA 消退的预测具有最高的灵敏度（91.3%）和特异性（92.9%）。
KD 患者的钙化性 CAA 较不易消退。动脉瘤的大小、形态和发病年龄可能是影响消退的因素。
