33 year old female with genetic cardiomyopathy s/p transplant 10/24/16 admitted for concern for acute rejection. Patient referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 100 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10), the LV mass index is 77 g/m2 (normal range 67+/-11), and the LV mass is 115 g (normal range 114+/-24). There is mild concentric left ventricular hypertrophy (~12-13 mm myocardial thickness at the mid wall). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time (of the septal and lateral wall) is mildly elevated (~1100 ms). The T2-STIR edema ratio is elevated (2.14, normal <2) and the extracellular volume fraction is normal (19%, normal <30%). The global relative enhancement ratio is within normal limits (<4). Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 130 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 65 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant.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 suboptimally assessed, but there is no gross pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 FindingsSternal wires present. 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 60%).2. The right ventricle is normal in size and systolic function (RVEF 50%). 3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. The pre-contrast native myocardial T1 relaxation time (of the septal and lateral wall) is mildly elevated (~1100 ms). The T2-STIR edema ratio is elevated (2.14, normal <2) and the extracellular volume fraction is normal (19%, normal <30%). The global relative enhancement ratio is within normal limits (<4). 