70 year old male with amyloidosis, s/p autologous SCT 5/2016, severe coronary atherosclerosis, HTN. Cardiac MRI 4/2016 with evidence of early cardiac amyloidosis but atypical findings noted (asymmetric hypertrophy, atypical LGE pattern). Referred for cardiac MRI to reassess for amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LVEDV is 190 ml (normal range 142+/-34), the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVESV is 82 ml (normal range 47+/-19), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LV mass is 107 g (normal range 164+/-36), and the LV mass index is 48 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. No intracavitary thrombus noted.  There is mild asymmetric left ventricular basal septal hypertrophy (septal thickness 14 mm; posterior wall thickness 8 mm) similar to previous Cardiac MR study. There is persistent focal mid-wall late gadolinium enhancement involving the basal inferoseptal wall which is atypical for infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is similar to the previous study.The native myocardial T1 relaxation times were not reliably obtained.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RVEDV is 181 ml (normal range 142+/-31), the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVESV is 83 ml (normal range 54+/-17), and the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely with no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is posterior mitral annular calcification. There is no systolic anterior motion of the mitral valve.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 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 normal in size with normal systolic function (LVEF 57%), stable form prior.2. Persistent asymmetric basal septal hypertrophy with focal late gadolinium enhancement in a "mid-wall stripe pattern" involving the hypertrophied basal inferoseptal wall similar to previous Cardiac MR study. This finding is still considered indeterminate for cardiac amyloidosis and may be seen in other infiltrative or inflammatory entities. This pattern is atypical for an ischemic etiology. Native myocardial relaxation T1 time values were not reliable.3. The right ventricle is normal in size with normal systolic function (RVEF 54%).4. Biatrial dilation. 