A 58 year old male with history of abnormal ECG (negative T waves in V1-V5) while he is asymptomatic. Referred to stress cardiac MRI for further evaluationMEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 198 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19), the LV mass index is 41 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Along the apical anterior wall, there is a bright signal of SSFP imaging. On the TI scout, the region behaves differently from fat, normal myocardium, and blood pool. The region does not demonstrate late gadolinium enhancement. Left AtriumThe left atrium is normal in size. 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 73 ml/m2 (normal range 82+/-16), the RVEDV is 166 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17). 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 trace 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 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 57%).4. Normal RV size and systolic function (RVEF 57%).5. Along the apical anterior wall, there is a bright signal of SSFP imaging. On the TI scout, the region behaves differently from fat, normal myocardium, and blood pool. The region does not demonstrate late gadolinium enhancement. The native myocardial T1 may be reduced in this area but the wall is fairly thin making measurement unreliable. The finding is not likely to represent an imaging artifact but the mechanism of the finding is unclear to me based on the available images. Recommend bringing patient back, at no charge, for more non-contrast imaging to better elucidate the abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.