Abstract
Background: Coronary aneurysms (CAA) appear around Day 10 of Kawasaki syndrome (KS). Enhanced perivascular echo brightness (PEB) is not widely accepted as a marker of vasculitis. To explore its utility in early diagnosis of KS, we examined interobserver agreement (IOA) and prevalence. Working definition: Appearance of bright broad echoes surrounding the coronary lumen extending for at least 1 cm along the artery, as compared to thin parallel echoes representing normal coronary artery walls distinct from the surrounding. Methods: IOA: 20 randomly mixed PEB positive and negative studies were reviewed blindly by 6 pediatric cardiologists after they were coached on the definition. Mean % IOA and 95% confidence intervals (CI) were calculated for presence/absence of PEB in right and left coronary arteries (RCA, LCA). Prevalence: 50 consecutive KS pts' echoes were reviewed for PEB and concomitant or subsequent coronary ectasia or aneurysm (CAE or CAA). Results: IOA: Overall IOA was 79.2% (95% CI: 74.4, 84.0). For RCA and LCA, IOAs were 76.7% (70.2, 83.1) and 81.7 (74.6, 88.7), respectively. Prevalence: 28/50 pts (56%) showed PEB in one or both CAs in the first echo. 13 and 4 of those (26% and 8%) showed CAE and CAA, respectively. PEB without CAE/CAA was noted on Day 7.2 + 4.24 (m + sd); PEB with CAE or CAA was noted on Day 9.29 + 5.77 (NS). PEB was noted in 11/18 (61%) typical KS pts (TKS), in 11/14 (79%) atypical KS pts (AKS) and in 4/14 (29%) possible KS pts (PKS) (p=0.025). All pts who later developed CAA or CAE initially showed PEB. All PEB-negative pts remained free of CAA or CAE. Conclusions: (1) PEB is a sufficiently objective finding. (2) PEB is detectable in majority of pts before Day 10. (3) PEB precedes CAE or CAA in some pts.
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Takahashi, M., Mason, W., Acherman, R. et al. Is Perivascular Echo Brightness a Reliable Marker of Coronary Arteritis in Acute Kawasaki Syndrome?. Pediatr Res 53, 177 (2003). https://doi.org/10.1203/00006450-200301000-00139
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DOI: https://doi.org/10.1203/00006450-200301000-00139
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