51 year old female with hypertension, hyperlipidemia, and chest pain with a history of LVH, abnormal stress test, and negative coronary angiogram. Referred for cardiac MRI. Left VentricleThere is mild qualitative thickening of the left ventricular apical walls. The left ventricle is normal in size and systolic function otherwise. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is transmural, diffuse late gadolinium enhancement in the anterior apex and apical walls that is atypical in pattern for infarction but may represent myocarditis or suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native T1 myocardial relaxation time is ~1050 ms (normal). There is no evidence of myocardial iron overload. Left AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 101 ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 37 ml (normal range 35+/-13). Right AtriumThe right atrium is normal sized. 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 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 normal in size and systolic function (LVEF 60%) except for wall thickening within the apical LV. There is transmural, diffuse late gadolinium enhancement in the anterior apex and apical walls that is atypical in pattern for infarction but may represent myocarditis or suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Recommend repeat cardiac MRI in 4-6 months or sooner if clinically warrented. 2. The right ventricle is normal in size and systolic function (RVEF 64%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.