In patients with Kawasaki disease (KD), serial evaluation of coronary artery aneurysms (CAAs) and luminal narrowing is essential for risk stratification and therapeutic management. Therefore, non-invasive assessment of the status of the coronary artery is of utmost importance in patient management. Multislice spiral computed tomography (MSCT) permits non-invasive visualization of the entire coronary artery system and was used in the evaluation of 4 patients with KD. CAAs and high-grade coronary artery stenoses were detected by MSCT and corroborated the findings of coronary angiograms performed within the previous 2 years. MSCT has the potential to be the standard diagnostic tool in adolescents with KD.