64 year old man with history of AL type amyloidosis who has been treated with chemotherapy with previous MRI suggestive of early cardiac involvement. He was referred for repeat cardiac MRI to evaluate for possible progression. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 84 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a focal area of late gadolinium enhancement in the basal inferior subendocardium, which was not seen previously, and the basal inferolateral wall. On the previous study this region was thought to represent fat, but review of images today is consistent with true late gadolinium enhancement. Left AtriumThe left atrium is moderately dilated. There is thickening of the interatrial septum. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 135 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 55 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 mild 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 FindingsThere is a right upper lobe nodule which was seen on the previous study; it measures 14mm x 13mm today which is grossly stable compared to last MRI scan. No significant pleural effusion. Small focal inferior splenic hyperintense lesion is also unchanged compared to previous MRI scan, which is reassuring. 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 LV size and systolic function (LVEF = 55%). There is mild left ventricular hypertrophy (posterior wall thickness 12mm) and septal hypertrophy (11mm) which is stable from previous. There is a focal area of late gadolinium enhancement in the basal inferior and inferolateral wall (present on previous study but thought to represent artifact), suspicious for an infiltrative process in this patient with amyloidosis history.2. Normal RV size and systolic function (RVEF = 59%). 3. Moderate biatrial dilatation with interatrial septal thickening. 4. At least mild mitral regurgitation. 5. Stable appearing right upper lobe nodule and stable splenic hyperintense focus. 