25 year old man with dilated non-ischemic cardiomyopathy, family history of heart failure (father with CHF in his 40's), referred for cardiac MR to evaluate for possible etiologies. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 181 ml/m2 (normal range: 74+/-15), the LVEDV is 478 ml (normal range 142+/-34), the LV end systolic volume index is 150 ml/m2 (normal range 25+/-9), the LVESV is 398 ml (normal range 47+/-19). There is global hypokinesis. There is mild late gadolinium enhancement in the mid inferoseptum at the RV insertion point, which can be seen in pulmonary hypertension. There is a focus of mild late gadolinium enhancement in the mid inferolateral and inferior wall which is atypical for previous infarction, and suggestive of previous inflammation, fibrosis or infiltrative process.The native T1 myocardial relaxation time is 1090ms in the basal septum. This value is borderline elevated.There is no evidence for myocardial iron overload (T2* relaxation time 30-38ms). There is no LV thrombus visualized on today's study. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 391 ml (normal range 142+/-31), the RV end systolic volume index is 107 ml/m2 (normal range 31+/-9), and the RVESV is 284 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least 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-moderate 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 upper normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right pleural effusion. 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. Severely dilated left ventricle with severely reduced systolic function (EF 17%). There are two foci of late gadolinium enhancement seen; one is located at the inferoseptum at the RV insertion point, which is a nonspecific finding that can be seen in pulmonary hypertension. There is a second focus of mild late gadolinium enhancement in the mid inferolateral and inferior wall which represents previous infiltration, inflammation or fibrosis. 2. No LV thrombus is visualized on today's study. 3. Severely dilated right ventricle with severely reduced systolic function (EF 27%). 4. Severe biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.