63 year old woman with history of PMR, recent admission with fevers, mild troponin elevation, referred for cardiac MRI for further evaluation of underlying ischemia or myocarditis.MEDICATIONS: ASA, Lipitor, metformin, Victoza, prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no late gadolinium enhancement to suggest prior myocardial infarction or underlying myocardial fibrosis, inflammation, or infiltration. The entire myocardium is viable. Additionally, there is no evidence of increased myocardial T2-signal or early gadolinium enhancement to suggest acute myocarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 34 g/m2, and the LV mass is 66 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. There is lipomatous hypertrophy of the interatrial septum.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 168 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "bovine arch" branching pattern (common origin of innominate and left common carotid artery).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. Normal pericardial thickness without evidence of acute pericarditis. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. There no evidence of myocardial infarction or underlying myocardial fibrosis, inflammation, or infiltration. No evidence of acute myocarditis. 4. Normal LV size and systolic function (LVEF 68%).5. Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.