66 year old female with history of AL amyloidosis, s/p pacemaker for tach-brady syndrome. Referred for MRI for follow up. Left VentricleThe left ventricle is normal in size and systolic function. There is moderate left ventricular hypertrophy. The basal anteroseptum is 14mm (similar to reported on previous study dated 4/2016). The overall LV ejection fraction is 56%, the LVEDV is 124 ml (normal range 109+/-23), the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVESV is 55 ml (normal range 31+/-10), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LV mass is 137 g (normal range 114+/-24), and the LV mass index is 74 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. Based on T1 scouts, the gadolinium kinetics are abnormal (i.e. myocardium and LV cavity null within 80ms of each other). There is diffuse late gadolinium enhancement, which is most pronounced in the basal inferolateral wall and also in the basal septal mid-wall. These findings are strongly suggestive of the diagnosis of cardiac amyloidosis. No intracardiac thrombus. An accurate myocardial T1 measurement is not available, possibly due to artifact from the pacemaker. Left AtriumThe left atrium is moderately dilated. No LAA thrombus.The atrial wall is thickened. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), and the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8). Pacemaker lead is noted in the RV apex. Right AtriumThe right atrium is dilated. Right atrial pacer lead noted. The atrial wall is thickened. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation. The main PA is mildly dilated and measures 32 mmTricuspid ValveThe tricuspid valve opens widely. There is a pacer lead through the tricuspid valve.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries. The thoracic aorta 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 drains normally into the right atrium. The IVC is dilated.PericardiumSmall pericardial effusion. Extracardiac FindingsWell-circumscribed lesions noted in the liver consistent with hepatic cyst. This study is not designed for the specific evaluation of extra-cardiac findings. If clinically indicated, a separate dedicated evaluation should be considered.
1.The left ventricle is moderately hypertrophied (IVSd=14mm) with normal systolic function. LV ejection fraction is 56%. There is evidence of abnormal gadolinium kinetics and diffuse late gadolinium enhancement most pronounced in the basal inferolateral wall and basal septal midwall. These findings are strongly suggestive of the diagnosis of cardiac amyloidosis. 2.The right ventricle isnormal in size and function. RVEF is 55%3.Biatrial enlargement and thickening.4.At least mild mitral regurgitation. 5.When compared to the prior study from 4/1/2016, the LV wall thickness is stable but difference between myocardial and LV cavity inversion time has decreased, which could represent increasing myocardial amyloid burden. Comparison of myocardial T1 times not possible. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.