A 55 year old male with cardiac amyloid diagnosed by PYP scan which confirmed a wild type TTR amyloid. Echocardiography showed normal left ventricular ejection fraction with reduced strain, left ventricular hypertrophy. Referred to cardiac MR for further evaluation Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 193 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 88 g/m2 (normal range 85+/-15), and the LV mass is 176 g (normal range 164+/-36). There is diffusely concentric hypertrophy up to 15mm. Based on myocardial tagging, there is mild hypokinesis at the base. There is a large amount of late gadolinium enhancement which is also worse at the base than the apex. It is present circumferentially along the endocardium throughout most of the heart and in some areas it is nearly transmural. The LV cavity and myocardium null at nearly the same time suggesting the presence of abnormal "gadolinium kinetics". The native myocardial T1 time is severely elevated in some regions (range 1075ms to 1265ms). These findings are diagnostic for cardiac amyloidosis. No evidence of iron overload. No intracavitary thrombus was noted.Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 180 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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. The left ventricle is normal in size and systolic function, the LVEF is 57%. There is moderate concentric hypertrophy.2. There is extensive late gadolinium enhancement, abnormal gadolinium kinetics, and severely elevated native myocardial T1 relaxation times. All of these are strongly suggestive of the diagnosis of cardiac amyloidosis. 3. The right ventricle is normal in size and systolic function, the RVEF is 60%. 4. There is moderate biatrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.