42yo female with history of biopsy proven pulmonary sarcoidosis, newly diagnosed non-ischemic cardiomyopathy with EF of 22% who was referred for cardiac MRI to evaluate for possible cardiac involvement of her sarcoid. Left VentricleThe left ventricle is dilated with severely reduced systolic function. There is global hypokinesis with regional variation. There is increased T2-STIR signal in the septum and inferolateral wall with an elevated myocardium: skeletal muscle ratio (2.2-2.9) which is consistent with myocardial edema. There are multiple areas of late gadolinium enhancement. There is patchy diffuse late gadolinium enhancement throughout the septum which spares the endocardium and is atypical for myocardial infarction, and suggests an infiltrative, inflammatory or fibrotic process. There is a small focus of late gadolinium enhancement in the apical anterior wall which spares the endocardium, also suggestive of an infiltrative, inflammatory or fibrotic process. There is a transmural area of late gadolinium enhancement in the basal inferolateral and inferior wall with preserved wall thickness, atypical for myocardial infarction and more suggestive for infiltrative, inflammatory or fibrotic process. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is qualitatively normal size with mildly reduced systolic function.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 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 a trivial pericardial effusion.Extracardiac FindingsBilateral lower lobe infiltrates. Lymphadenopathy 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. Cardiac volumes could not be quantified at this time; an addendum will be generated tomorrow with specific cardiac volumes and function. 2. Severe LV systolic dysfunction with several areas of atypical late gadolinium associated with increased myocardial T2-signal. These findings support the diagnosis of cardiac sarcoidosis in the inflammatory stage. 3. Normal RV size with mildly reduced systolic function.4. Mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.