technetium-tc-99m-exametazime and Mucocutaneous-Lymph-Node-Syndrome

Forty-nine children with Kawasaki disease were included in this study. Based on the severity of carditis as determined by Tc-99m HMPAO-labeled WBC heart scan, the children were separated into two groups. Group A (n=24) had significant carditis and group B (n=25) did not have significant carditis. The left and right ventricular ejection fractions (LVEF and RVEF) were evaluated by equilibrium multigated blood pooling ventriculography. Diameters of the left and right coronary arteries (LCA and RCA) were measured by two-dimensional echocardiography. The results showed that group A had lower LVEF and RVEF, but larger diameters of the LCA and RCA than those of group B patients. The sensitivity of significant carditis to predict left ventricular dysfunction, right ventricular dysfunction, LCA dilation and RCA dilation was 88.9, 70.6, 75, and 71.4%, respectively; the specificities were 100, 100, 100, and 67.9%, respectively. Our findings suggest that significant carditis determined by Tc-99m HMPAO-labeled WBC heart scan can accurately predict impaired ventricular function and coronary artery dilation.

Topics: Child, Preschool; Female; Gated Blood-Pool Imaging; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; Predictive Value of Tests; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Exametazime; Ultrasonography; Ventricular Dysfunction, Left

Kawasaki disease is a febrile disease of children notable for systemic vasculitis. There have been many previous reports of various complications, including disorders of the central nervous system. We evaluated cerebral perfusion during the acute stage in patients with Kawasaki disease.. Single-photon emission-computed tomography (SPECT) with 99mTc-hexamethylpropyleneamine oxime was performed in 21 children with acute stage Kawasaki disease. Follow-up SPECT and MRI were performed about 1 month after the first SPECT in patients who exhibited abnormal SPECT findings during the acute stage.. In 6 of 21 children SPECT imaging demonstrated localized cerebral hypoperfusion without abnormal neurological findings or clinical symptoms, and the follow-up SPECT and MRI approximately 1 month after the first SPECT revealed no abnormalities.. Some patients with Kawasaki disease have transient localized cerebral hypoperfusion at the acute stage.

Topics: Acute Disease; Cerebrovascular Circulation; Child, Preschool; Female; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Twenty-eight children (5 girls, 23 boys; age, 20.3 +/- 16.2 months) with Kawasaki disease (KD) were included in this study. The children were treated with aspirin plus intravenous injection of gamma globulin (IVGG). Both Tc-99m HMPAO labeled WBC heart imaging (Tc-WBC) and two-dimensional echocardiograms (2D-Echo) were used to evaluate the effects of IVGG on the most common cardiac presentations--carditis and dilated coronary arteries--in KD. After IVGG therapy, the results showed that 32.1% (9/28) carditis patients had improved; 39.3% (11/28) of patients had no significant change; 28.6% (8/28) of patients had severe changes, and there was no significant difference among the three groups by the evidences of Tc-WBC. Dilated coronary arteries (CA) became smaller in 32.1% (9/28) of patients; 53.6% (15/28) of patients had no definite change; 14.3% (4/28) of patients had dilated LCA that became larger; and borderline difference existed among the three groups, proved by 2D-Echo. Between the Tc-WBC and 2D-Echo, 35.7% (10/28) of patients had similar changes, and 64% (18/28) of patients showed incongruous changes; and there was little difference. In conclusion, Tc-WBC and 2D-Echo provide strong evidence of the existence of carditis and dilated coronary arteries in certain patients, even after IVGG treatment. The improvements of carditis and dilated coronary arteries were not correlated with each other after IVGG therapy.

Topics: Aspirin; Coronary Disease; Echocardiography; Female; Heart; Humans; Immunoglobulins, Intravenous; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Forty-one children (15 girls, 26 boys; ages 3.0 +/- 2.1 years) with Kawasaki disease (KD) were included in our study. The diameters of a total of 82 coronary arteries (CA), comprising 41 left (LCA) and 41 right (RCA), were computed by two-dimensional echocardiography (2D-Echo). If the diameter of the CA was > or = 20 mm, it was considered as dilated. The severity of the carditis was evaluated by [99mTc]HMPAO-labeled white blood cell (WBC) heart scans (Tc-WBC) carried out in all cases. On the basis of the results the children were divided into three groups. Group A children had the most severe carditis where the heart uptake was greater than the bone uptake; 11 of 32 (34.3%) of the CA in 16 cases were dilated. Group B had carditis of medium severity where the heart uptake was equal to the bone uptake; 11 of 28 (39.3%) of the CA in 14 cases were dilated. Group C had mild carditis where the heart uptake was less than the bone uptake; 9 of 22 (40.9%) of the CA in 11 cases were dilated. There were no significant differences among the three groups (p = 0.87 by a chi-squared test). We conclude that no definite relationship exists between the severity of carditis and the dilatation of the CA in children with KD.

Topics: Cardiomyopathy, Dilated; Child, Preschool; Dilatation, Pathologic; Echocardiography; Female; Humans; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Severity of Illness Index; Technetium Tc 99m Exametazime

Thirty-seven children (11 girls, 26 boys; aged 2.8 +/- 2.2 years) with Kawasaki disease (KD) were included in the study. The biventricular functions were evaluated by equilibrium multigated blood pooling ventriculography (EMBPV) and the severity of carditis was decided by Tc-hexamethylpropyleneamine oxime (HMPAO) labelled white blood cell (WBC) heart scans (Tc-WBC). The results showed that 43% (16/37) of the KD cases with the severe carditis by Tc-WBC had the worst left ventricular ejection fraction (LVEF) (55.4 +/- 15.6%) and right ventricular ejection fraction (RVEF) (43.7 +/- 12.2%) by EMBPV; 24% (9/37) of the cases with the mild carditis had the best LVEF (63.5% +/- 8.2%) and RVEF (53.7% +/- 11.2%); the remaining 32% (12/37) had moderately severe carditis and biventricular function (LVEF: 58.2 +/- 17.2% and RVEF: 46.9 +/- 19.5%). Because Tc-WBC cannot only detect the severity of carditis but also predict impairment of ventricular function accurately, the choice of Tc-WBC should be preferable for KD-a common inflammatory cardiovascular disease in children.

Topics: Child; Child, Preschool; Female; Gated Blood-Pool Imaging; Heart Diseases; Humans; Infant; Inflammation; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Ventricular Function

Eighteen patients with Kawasaki disease and suspected carditis (11 boys, 7 girls, mean age 18 months) in acute stages underwent Tc-99m HMPAO WBC imaging of the heart. Signs and symptoms subsided after conventional aspirin therapy and the intravenous injection of high-dose (400 mg/kg per day for 5 days) gamma-globulin treatments. Tc-99m HMPAO WBC imaging of the heart was arranged a second time to evaluate the effects of the treatments for carditis. The results showed that a significant difference existed in the severity of carditis before and after the treatments (P less than 0.001, by signed rank test), 39% (7/18) with significant improvement in severity of carditis, 50% (9/18) without definite change. However, 11% (2/18) became more severely ill after the treatments. Tc-99m HMPAO WBC imaging may be useful in detecting carditis in Kawasaki disease and in evaluating the effects of aspirin plus the newly recommended gamma-globulin for the treatment of carditis in Kawasaki disease.

Topics: Child, Preschool; Female; gamma-Globulins; Humans; Immunization, Passive; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Myocardial imaging with Tc-99m HMPAO WBC was used to detect myocarditis of Kawasaki disease in 103 infants and children (66 boys and 37 girls, mean age 3 years and 4 months). The clinical course of Kawasaki disease may be divided into three phases, from the onset of illness onset until all clinical symptoms and signs have disappeared. Twenty-four hour myocardial imaging was performed in anterior, LAO, and left lateral views. The grading system was as follows: score 0 less than bone uptake; 1 = bone uptake; 2 greater than bone uptake; and 3 greater than or equal to liver uptake. If the score was greater than or equal to 2, significant myocarditis was considered. The appearing ratio of myocarditis was 57% (13/23) in the first phase; 65% (15/23) in the second phase; 54% (31/57) in the third phase. No significant difference was demonstrated among the three groups of patients (P greater than 0.1, by Chi-square test). In conclusion, an occult myocarditis may continue in all three phases of Kawasaki disease, even if the clinical symptoms and signs had improved by the evidence of Tc-99m HMPAO labeled WBC scan to avoid advanced cardiac complication.

Topics: Child; Child, Preschool; Female; Humans; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Myocardial imaging with 99Tcm-HMPAO-labelled white blood cells (WBC) and 67Ga citrate was used to detect myocarditis in the acute phase of Kawasaki disease among 22 infants and children; 18 cases of myocarditis were detected by 99Tcm-HMPAO-labelled WBC heart scans, but only one case was detected by 67Ga citrate heart scans. In conclusion, 99Tcm-HMPAO-labelled WBC scanning provides a more sensitive method than 67Ga citrate scanning in the detection of myocarditis in Kawasaki disease.

Topics: Child, Preschool; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime