66 year old man with history of hypertension, diabetes and recently diagnosed non-ischemic cardiomyopathy, referred for cardiac MRI for evaluation of possible etiologies. Left VentricleThe left ventricle is severely dilated with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 148 ml/m2 (normal range: 74+/-15), the LVEDV is 256 ml (normal range 142+/-34), the LV end systolic volume index is 68 ml/m2 (normal range 25+/-9), the LVESV is 117 ml (normal range 47+/-19), the LV mass index is 121 g/m2 (normal range 85+/-15), and the LV mass is 210 g (normal range 164+/-36). There is moderate concentric left ventricular hypertrophy (septal wall thickness = 14mm). There is global hypokinesis. There is mild patchy late gadolinium enhancement in the basal inferior and basal lateral wall, which is atypical for myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 relaxation time is moderately elevated (1130-1160ms) in the basal and mid ventricular segments, which can be seen in early infiltrative or diffuse fibrotic states, such as cardiac amyloidosis. Although the gadolinium kinetics and pattern of late gadolinium enhancement are not classic for cardiac amyloidosis, the diagnosis should none-the-less be considered (in addition to other infiltrative processes) given the associated hypertrophy. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 132 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 FindingsThere is a right axillary lymph node which is borderline enlarged (9 x 10mm). 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. Severely dilated left ventricle with mildly reduced systolic function (LVEF 54%).2. There is mild patchy late gadolinium enhancement in the basal inferior and basal lateral wall, which is atypical for myocardial infarction and suggests the presence of a focal underlying fibrosing, infiltrative, or inflammatory process. Although the gadolinium kinetics and pattern of late gadolinium enhancement are not classic for cardiac amyloidosis, the diagnosis should none-the-less be considered (in addition to other infiltrative processes) given the associated moderate concentric hypertrophy. The diagnosis of myocardial iron overload and Fabry's is unlikely given the moderately elevated native myocardial T1 times.3. Moderately dilated right ventricle with mildly reduced systolic function (RVEF 46%).4. Biatrial dilatation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.