42 year-old female with pulmonary sarcoid. Referred for CMR to evaluate for cardiac sarcoid disease burden, evaluate disease progression. Left VentricleThe left ventricle is severely dilated. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 150 ml/m2 (normal range: 65+/-11), the LVEDV is 340 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 262 ml (normal range 31+/-10), the LV mass index is 93 g/m2 (normal range 67+/-11), and the LV mass is 211 g (normal range 114+/-24). There is inferior and inferolateral hypokinesis extending from the base to the apex. There is hyperenhancement on T2 STIR images in the lateral, inferolateral and septal walls (myocardial to skeletal muscle ratio 1.8-2.4). This appears similar to previous. There are multiple patchy areas of late gadolinium enhancement throughout the septum which spares the subendocardium and is atypical for myocardial infarction, and suggests an infiltrative, inflammatory or fibrotic process. There is a small focus of late gadolinium enhancement in the apical anterior wall, also suggestive of an infiltrative, inflammatory or fibrotic process. There is a transmural patch of late gadolinium enhancement in the basal inferolateral and inferior wall. When compared side-by-side with the previous MRI of 3/2016 the findings in this study are similar. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with mildly reduced ejection fraction. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RV ESV is 91 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.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 (29.7 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsInterstitial pattern at lung bases. There is lymphadenopathy. 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 severely dilated. The overall LV ejection fraction is 23%. There is inferior and inferolateral hypokinesis extending from the base to the apex. There is anteroseptal hypokinesis. 2. There is hyperenhancement on T2 STIR images in the lateral, inferolateral and septal walls (myocardial to skeletal muscle ratio 1.8-2.4) suggestive of myocardial edema and/or inflammation. There are multiple patchy areas of late gadolinium enhancement throughout the septum which spares the subendocardium which suggest an infiltrative, inflammatory or fibrotic process. There is a small focus of late gadolinium enhancement in the apical anterior wall, and a transmural patch of late gadolinium enhancement in the basal inferolateral and inferior wall. These findings appear similar to previous cardiac MRI 3/2016.3. The right ventricle is normal in size with mildly reduced ejection fraction. The overall RV ejection fraction is 47%4. Overall findings are similar to previous except for mild improvement in RV systolic function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.