MRI CARD W/VASODILATOR STRESS WWO CNTRST, 9/6/2016 10:48 AM First Pass PerfusionDuring hyperemia, a non-transmural, moderate sized perfusion defect was noted in the basal anterolateral wall and the mid inferior and inferolateral wall. The overall ischemic burden is 9% of the LV mass. Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 163 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 90 g. There is hypokinesis of the basal anterolateral and mid inferolateral walls. Native myocardial pre-contrast T1 relaxation time is mildly elevated in the septal mid myocardiumLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has evidence of flow acceleration suggesting at least mild aortic valve stenosis. Correlation with echocardiography suggested. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 FindingsLeft lung basilar discoid atelectasis, sternal wires consistent with previous bypass surgery. This 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. There is evidence of hibernating myocardium involving the basal anterolateral and mid inferior and inferolateral walls. This territory is ischemic and mostly viable. 2. There is a small myocardial infarction involving the basal anterolateral wall. 3. Normal LV size and systolic function (LVEF 58%). The native myocardial T1-relaxation time is mildly increased in the mid interventricular level suggesting the presence of interstitial fibrosis. 4. Normal RV size and systolic function (RVEF 55%).5. There is at least mild aortic stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.