66 year old woman with history of AL cardiac amyloid, s/p stem cell transplant, with recent increase in free light chains, referred for cardiac MRI for further evaluation of recurrent cardiac amyloid involvement. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 173 ml (normal range 109+/-23), the LV end systolic volume index is 47 ml/m2 (normal range 18+/-5), the LVESV is 99 ml (normal range 31+/-10). The interventricular septum thickness at end diastole is 12mm. There are no regional wall motion abnormalities present. Myocardial T1 times reflect underlying tissue properties, with studies describing healthy normal volunteers with times in 958 +/- 20 ms range. Cardiac amyloid increases myocardial T1 times, and a cut off of >1140ms is described for identifying patients with definite cardiac involvement and >1020ms as describing possible involvement. The interventricular septum, lateral and inferolateral myocardial T1 times are1076, 1061 and 1132 ms, indicating possible cardiac involvement.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. 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 drain normally into the right atrium. PericardiumThere is no significant 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 moderately dilated with normal systolic function. The overall LV ejection fraction is 57%.2. The interventricular septum, lateral and inferolateral myocardial T1 times are1076, 1061 and 1132 ms, indicating possible cardiac involvement.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.