50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with borderline systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 51 ml/m2 (normal range: 74+/-15), the LVEDV is 123 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small area of nontransmural mid wall late gadolinium enhancement in the lateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.6 which is in the normal range. The global relative enhancement is 2.9, which is in the normal range and has normalized since the last exam. The native myocardial T1 time in the interventricular septum is borderline at 1000-1100 ms, which is borderline/elevated and may indicate edema or fibrosis, but this value measures similarly to the previous study. The extra-cellular volume fraction (ECV) is 30%, which is similar to that obtained on the previous exam.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 53 ml/m2 (normal range 82+/-16), the RVEDV is 131 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is trace 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 FindingsSternotomy wires present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. Polycystic kidney disease, as before. 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. The left ventricle is normal in size with borderline systolic function. The overall LV ejection fraction is 54%. There are no regional wall motion abnormalities present. There is a small area of nontransmural mid wall late gadolinium enhancement in the lateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitative measurements for edema and inflammation essentially unchanged from previous scan. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. Compared to previous study, the small area of LGE is better seen today but was present on previous exam. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.