50 year old man with a history of ischemic cardiomyopathy, s/p heart transplant (4/30/2015) and antibody mediated rejection, hypertension and diabetes, referred for evaluation of rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 110 g (normal range 164+/-36). There are no regional wall motion abnormalities present. T2 edema ratio is >2 (mildly increased), which is suggestive of myocardial edema/inflammation. Global relative enhancement value is 4, which is borderline abnormal (normal <4) which may indicate an underlying inflammatory process. The myocardial native T1 time is 1206ms, which is significantly elevated, which may be indicative of an underlying infiltrative or inflammatory process. However, it is decreased from prior MRI on 2/26/16 (1282ms previously). The extracellular volume fraction is 26%, which is in the normal range. There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is better than before. It is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is enlarged consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 132 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 52 ml (normal range 54+/-17).Right AtriumThe right atrium is enlarged consistent with transplant.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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psudeo-bovine" brachiocephalic branching pattern (normal variant). 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 drain normally into the right atrium.PericardiumThe pericardium is essentially normal in thickness. Small portions of the pericardium is mildly bright on T2-weighted imaging suggesting that there is some subtle residual pericarditis. However, the amount of pericardium involved is less than on prior study on 2/26/16 and much less than on the initial cardiac MRI from 2015. Additionally, on the prior study on 2/26/16, the pericardium appeared bright on LGE imaging, however it does not on today's study. These findings indicate improvement of pericardial inflammation from the prior study. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of respirophasic septal shift. Extracardiac FindingsSternotomy wires are present. 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. The left ventricle is normal in size with normal systolic function (LVEF 56%). There is a small area of patchy late gadolinium enhancement in the mid inferoseptum, which is atypical of myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. It was present on prior MRI on 2/26/16 but is now less pronounced.2. The T2 ratio is mildly elevated, the global relative early enhancement is borderline elevated, and the native myocardial T1 relaxation time is significantly elevated. Together these parameters suggest that there may be some underlying myocardial inflammation present. However, the ECV fraction is normal, which would not support myocardial inflammation. When compared to the prior study, the T2 ratio and early global relative enhancement are slightly increased; where as the native myocardial T1 relaxation time is a little improved. Overall, I would conclude that there is no significant change of the myocardium. 3. There is only mild residual pericardial inflammation, which continues to decrease on his serial cardiac MRIs. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.