37 yo M with recent diagnosis of cardiomyopathy, large left-sided ACA/MCA stroke. Found to have a large apical thrombus. Referred for cardiac MRI to rule out infiltrative diseases. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%. The LVEDV is 340 ml (normal range 142+/-34), the LV end diastolic volume index is 162 ml/m2 (normal range: 74+/-15), the LVESV is 244 ml (normal range 47+/-19) and the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9). The LV mass is 294 g (normal range 164+/-36) and the LV mass index is 140 g/m2 (normal range 85+/-15). There is moderate left ventricular hypertrophy. There is global hypokinesis. The intraventricular septum measures 16 to 17 mm in thickness. There is patchy diffuse, subendocardial and transmural late gadolinium enhancement localized largely to the base to mid myocardium suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1100 ms (normal) in the ventricular septum and 1179 ms (abnormal) in the lateral ventricular wall. The latter value are suggestive of underlying diffuse fibrosis or infiltration.There is no obvious LV thrombus. Differential diagnosis of this pattern and distribution of late gadolinium enhancement includes infiltrative cardiomyopathies including cardiac amyloidosis.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 52%. The RVEDV is 252 ml (normal range 142+/-31), RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVESV is 122 ml (normal range 54+/-17), and the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is trivial to 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.AortaPseudo-bovine arch noted. Aortic sinus of valsalva 41 mm.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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%.There is global hypokinesis. 2.There is moderate left ventricular hypertrophy. The intraventricular septum measures 16 to 17 mm in thickness. 3.There is patchy diffuse, subendocardial and transmural late gadolinium enhancement localized largely to the base to mid myocardium suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1100 ms (normal) in the ventricular septum and 1179 ms (abnormal) in the lateral ventricular wall. The latter value are suggestive of underlying diffuse fibrosis or infiltration.Differential diagnosis of this pattern and distribution of late gadolinium enhancement includes infiltrative cardiomyopathies including cardiac amyloidosis.4.There is no obvious LV thrombus. 5.The right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 52%.These constellation of findings are suggestive of an infiltrative cardiomyopathy including cardiac amyloidosis. Cardiac biopsy may help determine the etiology if clinically appropriate. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.