72 year old woman with history of heart failure with preserved ejection fraction, hilar lymphadenopathy admitted for heart failure exacerbation, and now referred for cardiac MRI to evaluate for possible etiologies of her cardiomyopathy. 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 55 ml/m2 (normal range: 65+/-11), the LVEDV is 104 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 37 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There was significant motion artifact on late gadolinium imaging, but the following observations were made: there is late gadolinium enhancement in the basal inferolateral and lateral wall which is subendocardial and atypical for previous myocardial infarction. In addition there is a mid-myocardial stripe in the basal septum. The native myocardial T1 relaxation is abnormal (1142-1197ms), which could suggest underlying diffuse myocardial fibrosis or inflammation. The extracellular volume fraction is slightly elevated at 31%, which also suggests some degree of diffuse myocardial fibrosis or inflammation. There is no evidence for myocardial edema on T2-STIR imaging.Left AtriumThe left atrium is moderately dilated. The interatrial septum is bowed towards the right, suggestive of elevated left atrial pressures.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 81 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild 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 no pericardial effusion. There is no evidence of pericardial edema or inflammation.Extracardiac FindingsThere is bilateral hilar lymphadenopathy. There is a small well-circumscribed lesion at the posterior pole of the liver. 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. Normal sized left ventricle with normal systolic function (LVEF 65%)2. There was significant motion artifact on late gadolinium imaging, but the following observations were made: there is late gadolinium enhancement in the basal inferolateral and lateral wall which is subendocardial and atypical for previous myocardial infarction. In addition there is a mid-myocardial stripe in the basal septum. These findings could be consistent with an underlying inflammatory, infiltrative or fibrotic process. Sarcoid is included in the differential for this pattern of late gadolinium enhancement; however, given the quality of imaging a repeat study in 6 months could be considered. 3. Normal sized right ventricle with mildly reduced systolic function (RVEF 45%). 4. Biatrial dilation.5. See extracardiac findings.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.