65 year old male with a history of coronary artery disease s/p PCI to the left anterior descending artery in 2014 and amyloidosis s/p stem cell transplant in 2015 who is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There is moderate hypertrophy of the left ventricle (IVSd=14mm). The basal myocardial septal T1 relaxation time is 1099ms (upper limits of normal). There is diffuse circumferential late gadolinium enhancement involving the endocardial half of the myocardium. Although not reported on the prior study it was there also. This pattern is strongly suggestive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 118 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 47 ml (normal range 54+/-17). Right AtriumThe right atrium is mildly 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 no significant 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 no obvious pericardial disease.Extracardiac FindingsThere is a 11x11mm nodule in the right upper lobe of the lung. This is unchanged from the prior study. 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 in size and systolic function (LVEF 59%). There is moderate left ventricular hypertrophy with global, circumferential late gadolinium enhancement involving the endocardial half of the myocardium. This pattern is strongly suggestive of cardiac amyloidosis. 2. The right ventricle is normal in size and systolic function (RVEF 60%). 3. Mild biatrial enlargement. 4. Right upper lobe lung nodule, unchanged from prior study. 5. When compared to the prior study from 10/2015, the LV wall thickness has increased a little; however, there are no other obvious changes noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.