A 45 year old male with history of systemic and cardiac amyloidosis referred forMRI to evaluate the status of cardiac amyloidosis after chemotherapy (CyBorD) and stem cell transplant (ASCT). Left VentricleThe left ventricle is normal in size and systolic function. There is moderate to severe left ventricular hypertrophy (IVSd=15mm and PWd=17mm). The overall LV ejection fraction is 55%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19), the LV mass index is 74 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). There is hypokinesis of the basal segments. There is extensive, diffuse circumferential late gadolinium enhancement involving most of the endocardial surface of the left ventricle. Thegadolinium kinetics are mildly abnormal. The native myocardial T1 time is 1141ms (previously it was 1223ms). These findings are diagnostic of cardiac amyloidosis. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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 and systolic function (LVEF is 55%). There is moderate to severe concentric hypertrophy. There is hypokinesis of the basal segments.2. There is diffuse circumferential late gadolinium enhancement involving most of the endocardial surface of the left ventricle. The gadolinium kinetics are mildly abnormal. The native myocardial T1 is elevated. These findings are diagnostic of cardiac amyloidosis. Compared to the previous cardiac MRI, the native T1 time has improved slightly. 3. The right ventricle is normal in size and systolic function (RVEF is 55%). 4. The left and right atrium are mildly dilated. 5. There is mild aortic regurgitation.