79 year old woman with history of severe coronary calcification on CT, HTN, HL and an abnormal nuclear stress test who was referred for vasodilator stress cardiac MRI for further evaluation.MEDICATIONS: rosuvastatin, nebivolol, lisinopril, amlodipine First Pass PerfusionNo evidence of ischemia.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 61%, the LV end diastolic volume index is 59 ml/m2 (normal range: 65+/-11), the LVEDV is 95 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 47 g/m2, and the LV mass is 76 g. There are no regional wall motion abnormalities present.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is mildly thickened and opens widely.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation. Dedicated evaluation was not performed.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 pericardial effusion.Extracardiac FindingsThere is a rounded low-intensity signal focus at the last slice at the inferior field of view on axial images (301/1) measuring 9 x 9 mm. In the absence of outside imaging, recommend a CT thorax for further evaluation, to exclude pulmonary nodule. Mild levoscoliosis of the thoracolumbar spine.
1. No evidence of ischemia or myocardial infarct.2. Normal LV size and systolic function (LVEF 64%).3. Normal RV size and systolic function (RVEF 56%).4. A rounded focus is noted at the right costophrenic sulcus, incompletely imaged. If outside comparison imaging is not available, further evaluation with a CT thorax is recommended to exclude a pulmonary nodule.