A 75 year old male with recent hospitalization because of pulmonary embolism and newly diagnosed left ventricular dysfunction (LVEF by echocardiography was 35%), left ventricular hypertrophy. The electrocardiography showed low voltage and cardiac amyloidosis was clinical suspected. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. There is global hypokinesis with regional variation. There is severe concentric hypertrophy (wall thickness 15-17mm). The overall LV ejection fraction is 42%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 109 g/m2 , and the LV mass is 215 g. There is extensive and diffuse late gadolinium enhancement involving the whole myocardium, it is worst at the basal inferolateral wall. Addition on the inversion scouts the LV cavity and myocardium null within 30 seconds of each other. The native myocardial T1 time is 1100-1200msec. These findings are diagnostic for cardiac amyloidosis. No evidence of iron overload. Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17). The RV is mildly hypertrophied. Right AtriumThe right atrium is mildly dilated.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.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 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 mild systolic dysfunction. The LVEF is 42%. There is global hypokinesis with regional variation. There is severe hypertrophy. There is extensive and diffuse late gadolinium enhancement involving the whole myocardium, abnormal gadolinium "kinetics," and elevated native myocardial T1. These MRI findings are diagnostic of cardiac amyloidosis.2. The left atrium is moderately dilated. 3. The right ventricle is normal in size with mild systolic dysfunction and hypertrophy. The RVEF is 45%. 4. The right atrium is mildly dilated.