46 year old man with history of AL type amyloidosis with systemic and cardiac involvement, who underwent chemotherapy and stem cell transplant in 2014, now referred for serial cardiac MRI to monitor his cardiac involvement. Left VentricleThe left ventricle is normal in size with low-normal systolic function. There is severe left ventricular hypertrophy (IVSd=14mm and PWd=18mm). The overall LV ejection fraction is 54%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 94 ml (normal range 47+/-19), the LV mass index is 87 g/m2 (normal range 85+/-15), and the LV mass is 182 g (normal range 164+/-36). There is hypokinesis of the basal segments with preserved wall motion of the apical segments. Gadolinium kinetics are abnormal with early nulling of the myocardium. There is persistent subendocardial to mid-myocardial late gadolinium enhancement which involves the entirety of the left ventricle, with predominance in the basal anterolateral, basal inferior and basal-mid inferolateral walls. The native myocardial T1 relaxation time is 1250ms in the mid-ventricle segments, which is increased from prior (1141ms). Taken together, these findings are consistent with cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 98 ml/m2 (normal range 82+/-16), the RVEDV is 104 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 114 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial 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 a trivial pericardial effusion.Extracardiac FindingsThere are mild bilateral pleural effusions (right greater than left). There are dilated hepatic veins noted. 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 low-normal systolic function (LVEF is 54%). There is severe concentric hypertrophy. 2. There is diffuse circumferential late gadolinium enhancement involving the entirety of the left ventricular endocardium. The gadolinium kinetics are abnormal. The native myocardial T1 is elevated, increased from the prior study of 3/20/2015. Compared to the previous MRI, this constellation of parameters suggests progression of the disease.3. The right ventricle is normal in size with mildly reduced systolic function (RVEF is 44%). This has decreased when compared to the previous study.4. The left and right atrium are moderately dilated. 5. There is mild aortic regurgitation.6. There are mild bilateral pleural effusions. 7. There are dilated hepatic veins. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.