65 year-old male with unclear cardiomyopathy status-post dual chamber ICD with recent ICD discharges for ventricular tachycardia who is referred for cardiac MRI for further evaluation. The risks of cardiac MRI were discussed with the patient and consent was obtained to proceed. Left VentricleThe left ventricle is severely dilated and qualitatively appears to have severely reduced systolic function (LVEF 20-25%). Quantitative measurements are not possible due to artifact from ICD. There is global hypokinesis with regional variation There are two distinct areas of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The first is mid-wall and involves the basal anterior wall. The second is epicardial and involves the basal to mid inferior wall (near the right ventricular insertion point). Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveDue to ICD artifact, unable to accurately assess the valve. Mitral ValveDue to ICD artifact, unable to accurately assess the valve.Pulmonic ValveDue to ICD artifact, unable to accurately assess the valve.Tricuspid ValveDue to ICD artifact, unable to accurately assess the valve.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 severely dilated with severely reduced systolic function (LVEF 20-25%).2. The right ventricle is normal in size and function. 3. There are two distinct areas of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The first is mid-wall and involves the basal anterior wall. The second is epicardial and involves the basal to mid inferior wall (near the right ventricular insertion point). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.