Comparison of Tl-201 SPET and treadmill exercise testing in patients with Kawasaki disease

About 4% of children with Kawasaki disease ultimately develop ischaemic hea rt disease. Therefore, the early detection, non-invasive monitoring and lon g-term follow-up of myocardial ischaemia are essential. We compared the sen sitivity and specificity of Tl-201 Single photon emission tomography (SPET) and treadmill exercise in the detection of myocardial ischaemia in 23 pati ents (19 boys, 4 girls) with Kawasaki disease. They were divided into two g roups according to the results of coronary angiography. Group I consisted o f 11 patients with coronary abnormalities; Group II consisted of 12 patient s with no coronary abnormalities. The sensitivity, specificity, false-posit ive and false-negative rates for detecting coronary arterial lesions were 7 2.7% (8/11), 58.3% (7/12), 38.5% (5/13) and 30% (3/10) for Tl-201 SPET, and 45.5% (5/11), 100% (12/12), 0% (0/5) and 33.3% (6/18) for treadmill exerci se, respectively. We conclude that Tl-201 SPET is more sensitive than tread mill exercise for the detection of coronary arterial abnormalities, but tha t the specificity of treadmill exercise is better than that of Tl-201 scint igraphy. Coronary artery lesions detected by coronary angiography have good concordance of ischaemic areas with perfusion defects detected by Tl-201 S PET. When ischaemic findings on Tl-201 SPET and/or positive treadmill exerc ise testing are noted, coronary angiography is strongly indicated to detect possible stenotic lesions in the coronary arteries. ((C) 2000 Lippincott W illiams & Wilkins).