A 64 year old male with history of chronic lymphoid leukemia, now admitted due to syncope and found ventricular tachycardia on the electrocardiogram. During the current hospitalization the patient was catheterized and a stent was implanted in the left anterior coronary artery in a borderline lesion. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mild systolic dysfunction. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 96 ml (normal range 47+/-19), the LV mass index is 47 g/m2 (normal range 85+/-15), and the LV mass is 90 g (normal range 164+/-36). There mild hypokinesis of the basal infero- lateral and lateral walls, and of the apical anterior and inferior walls. Severe hypokinesis is demonstrated by the apical lateral wall. There is abnormal epicardial enhancement of the apical one-half of the lateral wall. The basal lateral and infero- lateral walls demonstrate patchy enhancement in a predominantly mid-myocardial distribution, sparing the subendocardium and atypical for infarct. No septal enhancement is noted. The differential diagnosis includes myocarditis, which may be active in the presence of wall motion abnormality. In the setting of prior chemotherapy exposure, myocardial chemotoxicity should also be considered. This was discussed with the clinical service in the ICU.No intracardiac thrombus.Left AtriumThe left atrium is upper limits normal size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17). No aneurysm or fatty infiltration in the myocardium. Right AtriumThe right atrium is upper limits of normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation, not quantified, with thickening of the free margin of the anterior leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation, not quantified.AortaThere is a left sided aortic arch. The 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 and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a focal T2 hyperintense abnormality in a lower thoracic vertebral body, right of midline, that is incompletely characterized. Further evaluation with dedicated spin echo imaging of the spine may be performed to better characterize.
1. The left ventricle is normal in size with mild systolic dysfunction, the LVEF is 49%. Wall motion abnormalities are noted in regions of enhancement, involving the lateral and inferolateral walls. The appearance is atypical of infarct, with considerations including myocarditis and myocardial chemotoxicity. 2. The right ventricle is normal in size with normal systolic function, the RVEF is 52%. No aneurysm or fatty infiltration in the myocardium. There are no MRI findings to suggest arrhythmogenic right ventricle cardiomyopathy. 3. There is a focal T2 hyperintense abnormality in a lower thoracic vertebral body, right of midline, that is incompletely characterized. Further evaluation with dedicated spin echo imaging of the spine may be performed to better characterize.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.