75 year old male with history of MDS, coronary artery disease, reduced systolic function, now with dyspnea and palpitations who presents for stress cardiac MRI to evaluate for myocardia ischemiaMEDICATIONS: atenolol, glimepride, simvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted on the rest and stress images. Viability/ Myocardial ScarThere is small near transmural late gadolinium enhancement in a pattern of myocardial infarction noted in the apical lateral wall. This small segment is not likely to be viable. There is subtle epicardial late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying myocardial fibrosing, inflammatory, or infiltrative process. The viability of this segment is indeterminate. The remainder of the left ventricle is without late gadolinium enhancement and is likely to be viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 103 g. There is hypokinesis of the apical lateral wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 small pericardial disease.Extracardiac FindingsThere are moderate-large bilateral pleural effusions. There is evidence of iron overload of the liver. Mediastinal lymphadenopathy is 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. No perfusion defects/ "ischemia" present during hyperemia.2. There is small near transmural myocardial infarction noted in the apical lateral wall. This small segment is not likely to be viable. There is also subtle epicardial late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying myocardial fibrosing, inflammatory, or infiltrative process. The viability of this segment is indeterminate. The remainder of the left ventricle is without late gadolinium enhancement and is likely to be viable. 3. The left ventricle is normal in size with low normal systolic function [LVEF 51%] with apical hypokinesis.4. The right ventricle is normal in size with normal systolic function [RVEF 61%]5. Small pericardial effusion. 6. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.