26 year old man with history of hypertension, diabetes, sarcoidosis, presenting with new onset heart failure, referred for cardiac MRI for further evaluation of possible underlying etiologies of heart failure. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 174 ml/m2 (normal range: 74+/-15), the LVEDV is 353 ml (normal range 142+/-34), the LV end systolic volume index is 150 ml/m2 (normal range 25+/-9), the LVESV is 306 ml (normal range 47+/-19), the LV mass index is 101 g/m2 (normal range 85+/-15), and the LV mass is 205 g (normal range 164+/-36). LV dysfunction is global with regional variation. Although there is no focal late gadolinium enhancement noted, which would typically suggest no myocardial infiltration, inflammation, or fibrosis, the global relative enhancement (3.0-3.5) and native myocardial T1 times (~1150ms) are both elevated suggesting that there may be diffuse myocardial inflammation or fibrosis.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 242 ml (normal range 142+/-31), the RV end systolic volume index is 92 ml/m2 (normal range 31+/-9), and the RVESV is 187 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bi-leaflet tethering of the mitral valve without significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThere is tethering of the tricuspid valve. 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. The IVC is dilated. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are small bilateral pleural effusions, right greater than left. 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. Severe LV dilation with severely reduced systolic function (LVEF 13%). Although there is no focal late gadolinium enhancement noted, which would typically suggest no myocardial infiltration, inflammation, or fibrosis, the global relative enhancement (3.0-3.5) and native myocardial T1 times (~1150ms) are both elevated suggesting that there may be diffuse myocardial inflammation or fibrosis. Given the clinical context of known sarcoidosis, these findings would support the diagnosis of cardiac sarcoidosis. A cardiac FDG-PET scan may be helpful. 2. Normal RV size with severely reduced systolic function (RVEF 23%). 3. Small pericardial effusion. 4. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.