68 year old male with history of hyperlipidemia and anginal symptoms who presents for cardiac MRI to evaluate for ischemiaMEDICATIONS: aspirin, Lipitor, metoprolol First Pass PerfusionDuring hyperemia, there is a severe, large sized defect in the basal to mid inferior and inferoseptum and the apical inferior and septal walls. Additionally, there is a mild perfusion defect involving all of the other segments in the mid ventricle and and the apical anterior wall. Viability/ Myocardial ScarThere is a small subendocardial basal inferior late gadolinium enhancement involving approximately 25-50% of the wall thickness, suggesting prior non-transmural myocardial infarction. This segment has an intermediate probability of viability. The remainder of the myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 139 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 114 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 50 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 ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe ascending aorta is mildly dilated (39x41mm). There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. There is a large, severe perfusion defect in the territory of the right coronary artery. There are additionally mild perfusion defects noted in the usual territory of the mid LAD and mid LCx arteries.2. There is a small non-transmural myocardial infarction involving the basal inferior wall. This segment has an intermediate probability of viability. The remainder of the myocardium is viable. 3. Normal LV size and systolic function (LVEF 71%).4. Normal RV size and systolic function (RVEF 67%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.