Efficacy of Iodine-123-15-(p-iodophenyl)-3-R, S-Methylpentadecanoic Acid Single Photon Emission Computed Tomography Imaging in Detecting Myocardial Ischemia in Children With Kawasaki Disease

• Published in: Circulation Journal 2003, Vol.67(8), pp.663-666
• Main Authors: Hoshina, Masaru, Shiraishi, Hirohiko, Igarashi, Hiroshi, Kikuchi, Yutaka, Ichihashi, Kou, Momoi, Mariko Y.
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; BMIPP; Cardiology. Vascular system; Case-Control Studies; Child; Child, Preschool; Coronary Aneurysm - complications; Coronary Aneurysm - diagnostic imaging; Coronary Aneurysm - etiology; Coronary Angiography; Coronary artery stenosis; Coronary heart disease; Coronary Stenosis - complications; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - etiology; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Kawasaki disease; Male; Medical sciences; Mucocutaneous Lymph Node Syndrome - complications; Myocardial ischemia; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - etiology; Sensitivity and Specificity; SPECT imaging; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon - standards
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.67.663

To evaluate its efficacy in detecting myocardial ischemia in children, iodine-123-labeled 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP) myocardial single photon emission computed tomography (SPECT) imaging was performed in 16 pediatric patients with Kawasaki disease (KD, 11 male, 5 female; mean age and range: 13 years 8 months and 8 years 11 months to 17 years 7 months). Five children with chest pain and no cardiac disease were studied as controls (2 male, 3 female; mean age and range: 13 years 4 months and 9 years 4 months to 17 years 11 months). Selective coronary angiography was also performed in the 16 patients to evaluate the location of coronary stenosis and coronary aneurysms. The SPECT images were expressed as polar maps (Bull's eye maps) and the `defect' area was defined as where the uptake of BMIPP was less than the standardized BMIPP images of the 5 control children. In the 16 patients, 33 segments had coronary aneurysms and 10 (10/33: 30.3%) had significant coronary stenosis on selective coronary angiography. Nine of the 10 (90%) segments with significant coronary stenosis showed a defect on the BMIPP image whereas only 6 of the 23 (26.1%) segments without coronary stenosis showed a defect on BMIPP imaging. The sensitivity of BMIPP SPECT imaging for detection of coronary stenosis was 90% (9/10) and its specificity was 73.9% (17/23), whereas the sensitivity of 201Tl SPECT imaging was 80% (8/10) and its specificity was 60% (14/23). There was no significant difference between the BMIPP and 201Tl SPECT images in either the sensitivity or specificity for the detection of coronary stenosis. In the present series, only one case had discordant BMIPP uptake (BMIPP uptake < 201Tl uptake) in which there was a large coronary aneurysm and re-canalization after complete obstruction at segment 1 of the right coronary artery. This discordant BMIPP uptake reflects the possibility of ischemic but viable myocardium after re-canalization of a large aneurysm in KD. In conclusion, BMIPP SPECT imaging is useful for detecting the areas of ischemic myocardium caused by coronary artery stenosis in children with KD. (Circ J 2003; 67: 663 - 666)