MRI CARD W/VASODILATOR STRESS WWO CNTRST, 11/13/2015 1:00 PM First Pass PerfusionDuring hyperemia, there was a perfusion defect noted in the inferior wall.Viability/ Myocardial ScarThere is late gadolinium enhancement noted in the basal inferolateral wall. The pattern is not typical of myocardial infarction and could be consistent with fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is mild to moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%, the LV end diastolic volume index is 117 ml/m2 (normal range: 74+/-15), the LVEDV is 245 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19), the LV mass index is 62 g/m2, and the LV mass is 131 g. There is hypokinesis of the basal to mid inferoseptum, inferior and inferolateral walls. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mild to moderately dilated.Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe SOV measures 35mm. The ascending aorta measures 42mm. The aortic arch prior to the inominate artery is 38mm. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is moderate atherosclerosis of the descending thoracic aorta.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 a small pericardial effusion.Extracardiac FindingsThere is a small left pleural effusion. 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. There is a perfusion defect noted in the inferior wall.2. There is late gadolinium enhancement noted in the basal inferolateral wall. The pattern is not typical of myocardial infarction and could be consistent with fibrosis, inflammation, or infiltration. The entire myocardium is viable.3. The left ventricle is mild to moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 35%There is hypokinesis of the basal to mid inferoseptum, inferior and inferolateral walls.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.5. Dilation of the ascending aorta (measurements as above).6. There is a small pericardial effusion. Consider transthoracic echo for further evaluation and follow up.7. Bi-atrial enlargement. 8. See extra cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.