56 year old woman with history of palpitations, 1st degree AV block and likely scleroderma, referred for cardiac MRI for further evaluation of possible underlying infiltrative disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 101 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 36 ml (normal range 31+/-10), the LV mass index is 24 g/m2 (normal range 67+/-11), and the LV mass is 24 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying focal or replacement fibrosis, infiltration, or obvious inflammation. Her native myocardial T1-times are borderline elevated (1050-1100ms), which could represent low grade inflammation or fibrosis; however, very little is published about native myocardial T1 times in scleroderma patients and the clinical relevance of this finding is unknown.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 97 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.
1. Normal LV size and systolic function (LVEF 65%) without underlying late gadolinium enhancement (i.e. replacement/ focal myocardial fibrosis, obvious inflammation, or infiltration). The native myocardial T1-times are borderline elevated (1050-1100ms), which could represent low grade inflammation or fibrosis; however, very little is published about native myocardial T1 times in scleroderma patients and the clinical relevance of this finding is unknown.2. Normal RV size and systolic function (RVEF 70%).3. Normal pulmonary artery size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.