Pericoronary Adipose Tissue CT Attenuation in Kawasaki Disease and Association with Coronary Artery Aneurysms, Myocardial Perfusion, and Coronary Events.

Purpose To evaluate coronary inflammation using pericoronary adipose tissue (PCAT) CT attenuation in patients with Kawasaki disease (KD) and determine the association of PCAT CT attenuation with coronary artery aneurysm (CAA), myocardial perfusion, and future coronary events (CEs). Materials and Methods This retrospective study included patients with KD and healthy controls who underwent coronary CT angiography (CCTA). Some patients also underwent cardiac MRI within 2 weeks of CCTA. Patients were split into subgroups according to presence or absence of CAA. PCAT CT attenuation and cardiac MRI-based myocardial perfusion were measured. CEs, including coronary artery thrombosis, obstruction, stenosis, procedural events, and acute ischemic events, were recorded. Associations were assessed using univariable and multivariable regression analyses and Spearman correlation analysis. Results One hundred patients with KD (mean age, 7.5 years ± 3.6 [SD]; 79 male) and 35 healthy controls (mean age, 8.4 years ± 2.8; 18 male) were included. Mean PCAT CT attenuation was higher in patients with CAA (n = 64) than in patients without CAA (n = 36) and healthy controls (-67.1 HU ± 6.4 vs -75.0 HU ± 8.6 and -77.0 HU ± 8.5, respectively; both P < .001). CAA presence (β = 7.20; P < .001) was independently associated with mean PCAT CT attenuation. Mean PCAT CT attenuation was negatively correlated with the global myocardial perfusion index (n = 18; r = -0.50; P = .02). During a median follow-up period of 19.7 months, 18 of 100 patients (18%) experienced CEs. Both mean PCAT CT attenuation (odds ratio [OR], 1.20 [95% CI: 1.00, 1.30]; P = .007) and the Z-score of the largest CAA (OR, 1.30 [95% CI: 1.10, 1.50]; P = .01) independently predicted CE occurrence. Conclusion In patients with KD, higher mean PCAT CT attenuation was associated with CAA presence and decreased myocardial perfusion and independently predicted occurrence of CEs. Keywords: Kawasaki Disease, Coronary CT Angiography, Pericoronary Adipose Tissue CT Attenuation, Coronary Artery Aneurysm, Myocardial Perfusion, Coronary Events Clinical trial registration no. ChiCTR2300076398 Supplemental material is available for this article. © RSNA, 2025.