65 year old male with history of coronary artery disease and previous MI and mild cardiac amyloidosis by previous cardiac MRI, now s/p stem cell transplant. He is referred for repeat cardiac MRI to evaluate for interval changes in amyloid involvement. Left VentricleThe left ventricle is normal in size with normal systolic dysfunction. The overall LV ejection fraction is 56%, which is improved from the previous study of September 2015. The LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 168 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19). There is mild hypertrophy of the basal anterior septum (11mm). There is hypokinesis of the basal to mid inferior wall and basal inferolateral wall. There is persistent late gadolinium enhancement at the basal and middle segments of the inferior, inferoseptal, and infero-lateral walls which is subendocardial and consistent with previous myocardial infarction. It involves >50% of the myocardium, suggesting low probability of viability . No other late gadolinium enhancement is seen; however, a low inversion time was selected which may mask the presence of diffuse late gadolinium enhancement related to amyloid. The TI scouts show that the myocardium nulls at a lower than expected T1 time suggesting that the gadolinium "kinetics" are mildly abnormal. The native T1 myocardial relaxation time is elevated at 1218ms in the septum; this is stable compared to the previous study. The extracellular volume fraction is elevated at 39%. Together all of these findings suggest the presence of early cardiac amyloidosis which is stable when compared to the prior study. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 107 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).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 trivial 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 and drain normally into the right atrium. There is an SVC catheter.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere are small bilateral effusions, right greater than left. There is mild atherosclerosis in the descending aorta. 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 dysfunction, the LVEF is 56%, which is improved from the previous study. There is mild left ventricular hypertrophy of the basal anterior septum (11mm). There is hypokinesis of the basal to mid inferior wall and basal inferolateral wall.2. There is a nearly transmural myocardial infarction involving the basal to mid inferior, inferoseptum, and inferolateral walls. These segments have a low probability of viability.3. The native myocardial T1-value, ECV fraction, and decreased inversion time on T1 scout all suggest the presence of early cardiac amyloidosis. When compared to the prior study, these values are essentially unchanged. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. 5. SVC catheter. 6. Bilateral pleural effusions. When compared to the prior study, the LVEF is a little better; otherwise, the study is essentially unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.