49 year old female with history of HIV, hypertension and moderate LV dysfunction who was referred for cardiac MRI to evaluate possible etiologies of her cardiomyopathy. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. Qualitatively, on images acquired without ectopy, the ejection fraction is approximately 40-45%; where as, images acquired with a lot of ectopy, the ejection fraction is 30-35%. Quantitatively (which has its limitations due to frequent ectopy), the overall LV ejection fraction is 40%, the LV end diastolic volume index is 122 ml/m2 (normal range: 65+/-11), the LVEDV is 262 ml (normal range 109+/-23), the LV end systolic volume index is 73 ml/m2 (normal range 18+/-5), the LVESV is 158 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of a focal underlying fibrosing, infiltrative, or inflammatory process. Native T1 myocardial relaxation time is borderline elevated at 1080-1090ms, but the extracellular volume fraction is 22%, which is within normal limits. These values suggest possible early stages of underlying diffuse underlying fibrosis or infiltration.There is no evidence of myocardial iron overload. There is no evidence for myocardial edema. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 53 ml/m2 (normal range 22+/-8), and the RVESV is 115 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 ValveThere is bileaflet tethering of the mitral valve leaflets. There is moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial 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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion. There is a 3cm x 3.6cm mass located at the right diaphragmatic border of the heart, which most likely is a pericardial cyst.. There is no pericardial enhancement or edema.Extracardiac FindingsThis 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 severely dilated with moderately reduced systolic function (EF 40%). See above for more detailed description of LV function. 2. There is no late gadolinium enhancement, which suggests that there is no evidence of replacement fibrosis. The extra-cellular volume fraction is also within normal limits suggesting the absence of significant infiltrative or inflammatory processes. The native myocardial T1 relaxation time is borderline increased which could suggest the presence of mild, diffuse, interstitial fibrosis. 3. The right ventricle is normal in size with mildly reduced systolic function (EF 41%). 4. Bileaflet mitral leaflet tethering with moderate mitral regurgitation. 5. There is a 3cm x 3.6cm mass located at the right diaphragmatic border of the heart, which most likely is a pericardial cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.