51 year old woman with history of systolic heart failure, palpitations, and fatigue who presents for cardiac MRI to evaluate for etiology of LV dysfunction and symptoms. Left VentricleThe left ventricle is mildly dilated with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 153 ml (normal range 109+/-23), the LV end systolic volume index is 53 ml/m2 (normal range 18+/-5), the LVESV is 91 ml (normal range 31+/-10), the LV mass index is 29 g/m2 (normal range 67+/-11), and the LV mass is 49 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement involving the basal to mid inferior wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. No evidence of myocardial iron overload. No evidence of cardiac amyloid.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 102 ml/m2 (normal range 69+/-14), the RVEDV is 174 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 86 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 mild 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 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 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 mildly dilated with mild to moderately reduced systolic function [LVEF 40%]2. There is epicardial late gadolinium enhancement involving the basal to mid inferior wall. The pattern is atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is most consistent with fibrosis due to old myocarditis, but can also be seen with other types of cardiomyopathy. The overall burden of late gadolinium enhancement is small.3. Mild RV dilation with normal systolic function (RVEF 50%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.