55 year old female with non-obstructive CAD, DM< HTN, OSA, chest pain, NSTEMI. LVEF 60% with unexplained apical hypokinesis. Referred for cardiac MRI to rule out myocarditis. Left VentricleThe left ventricle is mildly dilated with normal systolic function. There is a small focal area of apical inferior wall hypokinesis. The overall LV ejection fraction is 66%. The LVEDV is 178 ml (normal range 109+/-23), LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), LVESV is 61 ml (normal range 31+/-10), and LV end systolic volume index is 25 ml/m2 (normal range 18+/-5). The LV mass is 134 g (normal range 114+/-24) and the LV mass index is 54 g/m2 (normal range 67+/-11). There is a small, focal, subendocardial, non-transmural, late gadolinium enhancement in the apical inferior wall. The pattern is suggestive of a very small myocardial infarction. The native T1 myocardial relaxation time is elevated at 1150-1160 ms, suggestive of underlying diffuse fibrosis.There is no myocardial iron overload.Left AtriumThe left atrium is mildly dilated .Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 64%, the RVEDV is 200 ml (normal range 110+/-24), the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVESV is 72 ml (normal range 35+/-13), and the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is mildly dilated . Aortic ValveThe aortic valve is trileaflet, 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 (45 mm) is severely dilated. Right and left branch pulmonary arteries are dilated (RPA 22 mm, LPA 23 mm).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 mildly dilated with normal systolic function. LVEF 66%. 2.There is a small apical inferior wall motion abnormality caused by a small non-transmural myocardial infarction.3.There is mild left ventricular hypertrophy with mildly increased native myocardial T1-relaxation times suggestive of mild, diffuse, interstitial fibrosis.4.The right ventricle is mildly dilated with normal systolic function. RVEF 64%.5.Severe dilation of the main pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.