A 62 year old female with history of extra-cardiac sarcoid, right lung cancer (treated with surgical resection and radiotherapy). Recently she suffered from a transient ischemic attack (TIA) and mild-to moderate left ventricular function was found in an echocardiography. Referred to cardiac MRI to assess cardiac sarcoid and coronary artery disease. MEDICATIONS: Aspirin, Atorvastatin, Clonazepam, Fluticasone, Lanzoprazole, Zolpidem First Pass PerfusionDuring hyperemia, a small, moderate severity perfusion defect present in the basal anterolateral wall. The overall ischemia burden is 2 out of 32 and 6% of the myocardium is ischemic.Viability/ Myocardial ScarThere is no clear cut late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. There is, however, a borderline increase in signal intensity in a small area of the basal anterolateral wall which I believe is an imaging artifact.Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 107 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 61 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 81 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 38 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.AortaThe aortic root is normal in size. 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 FindingsConsolidation is noted in the lower lobe of the right lung; no significant change in size compared to this finding in the Chest CT from 12/6/2011. 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. A small, moderate severity perfusion defect/ "ischemia" is present in the basal anterolateral wall.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 45%) without obvious evidence of underlying myocardial fibrosis, inflammation, or infiltration. If there is a high clinical suspicion of cardiac sarcoidosis, consider repeat cardiac MRI in 6-12 months to reassess the above described increased signal intensity involving the basal anterolateral wall. 4. Normal RV size and systolic function (RVEF 54%).5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.