63 year old man with history of heart transplant in 2005, chronic kidney disease and recent endomyocardial biopsy positive for mild rejection referred for cardiac MRI to further evaluate. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 128 g (normal range 164+/-36). There is mild left ventricular hypertrophy (12mm in the mid septum). The apex is thinned and aneurysmal with evidence of increased T2-signal suggesting that the process may have occurred within the past 4-6 weeks.The native T1 myocardial relaxation time is 1120ms, which is elevated and suggests the presence of diffuse underlying fibrosis or infiltration. The T2-STIR myocardial:skeletal muscle ratio is upper normal. There is no myocardial iron overload.No obvious left ventricular thrombus noted; however, contrast was not used in this study.Left AtriumThe left atrium is enlarged, consistent with previous transplant surgery. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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 extensive epicardial fat. There is no pericardial edema or effusion.Extracardiac FindingsSternotomy wires are 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 with normal systolic function (EF 63%). The apex is thinned and aneurysmal with increased myocardial T2-signal suggesting that the patient may have had an infarction within the last 4-6 weeks.2. The native T1 myocardial relaxation time is mildly elevated, which may signify mild underlying diffuse infiltration or fibrosis. 3. The right ventricle is normal in size with normal systolic function (EF 65%). 