64 year old man with history of new onset heart failure, with non-ischemic cardiomyopathy referred for cardiac MRI to evaluate for possible etiologies. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 140 ml (normal range 47+/-19), the LV mass index is 76 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). There is moderate concentric hypertrophy (septal thickness 13mm). There is global hypokinesis with regional variation. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum, which is atypical for myocardial infarction. There is also an area of late enhancement in the basal to mid inferolateral wall which is transmural but within a thickened wall, which is atypical for myocardial infarction. There is a small area of epicardial late gadolinium enhancement in the mid anterolateral wall which is atypical for prior myocardial infarction. These findings suggests an underlying infiltrative, inflammatory or fibrotic process such as myocarditis. The native T1 relaxation time is 1020-1030ms, but the extra-cellular volume fraction is 42% which is elevated and also supports an underlying inflammatory, infiltrative, or fibrosing process. Left AtriumThe left atrium is moderately dilated. The interatrial septum is aneurysmal. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 22%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 211 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 158 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflet tips appear tethered, and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta is mildly dilated and measures 42mm at the level of main PA bifurcation.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (37mm).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 LV is normal in size with moderately reduced systolic function (EF 33%) with moderate concentric hypertrophy. 2. There are multiple areas of late gadolinium enhancement seen and the ECV fraction is significantly elevated. These findings are atypical for infarction, and suggests an infiltrative, inflammatory or fibrotic process. 3. The RV is normal in size with severely reduced systolic function (EF 22%). 4. Main pulmonary artery moderately dilated. 5. There is moderate mitral regurgitation.6. Aneurysmal interatrial septum. 7. Ascending aorta is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.