A 71 year old male with diabetes mellitus, hypertension, hyperlipidemia, severe chronic kidney disease. Recently diagnosed with amyloid based on liver biopsy. A recent echocardiography showed preserved left ventricular systolic function. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 84 g/m2 (normal range 85+/-15), and the LV mass is 157 g (normal range 164+/-36). There is hypokinesis of the base and preserved contractility at the mid and apical segments. There is concentric hypertrophy, maximal at the basal anterior and antero-septum walls (16mm).On T1-mapping, basal T1 levels were between 1200-1300ms, mid-segment T1 values were in the range of 1050-1150ms. Apical segments had the lowest values (1070-1100ms). This pattern of T1 times could be consistent with amyloidosis. Intracavitary T1 time = 1430 ms and normal T1 times ~<1000. No intracavitary thrombus was seen. No iron overload was noted in the myocardiumLeft AtriumThe left atrium is mild-moderately dilated (114ml). The left atrial wall is thickened.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 57 ml (normal range 54+/-17). There is mild right ventricular hypertrophy (5 mm).Right AtriumThe right atrium is mild-moderately dilated.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 mild to moderate 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 a small pericardial effusion without evidence of hemodynamic compromise.Extracardiac FindingsBilateral moderate pleural effusions. No iron overload was noted in the liver. 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. The left ventricle is normal size with mildly reduced systolic function, the LVEF is 47%. 2. There is concentric hypertrophy, maximal at the basal anterior and antero-septum walls (16mm).3. On T1-mapping, basal T1 levels were between 1200-1300ms, mid-segment T1 values were in the range of 1050-1150ms. Apical segments had the lowest values (1070-1100 ms). 4. The right ventricle is normal in size with low normal systolic function, the RVEF is 50%. There is mild right ventricular hypertrophy5. There is biatrial enlargement. 6. There is mild to moderate tricuspid regurgitation.7. There is a small pericardial effusion.8. Bilateral moderate pleural effusions. These findings could be consistent with cardiac amyloidosis. Clinical correlation required. 