53 year old woman with history of palpitations, LV dysfunction and previous non-sustained ventricular tachycardia who presents for cardiac MRI to evaluate for possible etiologies of her cardiomyopathy. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 39%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 57 ml/m2 (normal range 18+/-5), the LVESV is 110 ml (normal range 31+/-10), the LV mass index is 49 g/m2 (normal range 67+/-11), and the LV mass is 94 g (normal range 114+/-24). There is global hypokinesis. There is no definitive areas of late gadolinium enhancement to suggest the presence of underlying focal myocardial fibrosis, inflammation, or infiltration. The global relative enhancement and T2-STIR ratios are both within normal limits. However, the inversion time on the TI scout is lower than expected and the native myocardial T1 time is moderately elevated (between 1130 and 1160ms) throughout most of the myocardium, which is elevated, and the extracellular volume fraction is 50%, which is very elevated. The findings suggest that there may be a significant increase in the extracellular volume due to diffuse fibrosis, inflammation, or infiltration.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 34%, the RV end diastolic volume index is 64 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 82 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 ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is thickening of the anterior mitral leaflet tip. 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 a trivial pericardial effusion.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. Mildly dilated left ventricle with moderately reduced systolic function (39%), with global hypokinesis.2. There is no definitive areas of late gadolinium enhancement to suggest the presence of underlying focal myocardial fibrosis, inflammation, or infiltration. The global relative enhancement and T2-STIR ratios are both within normal limits. However, the inversion time on the TI scout is lower than expected and the native myocardial T1 time is moderately elevated (between 1130 and 1160ms) throughout most of the myocardium, which is elevated, and the extracellular volume fraction is 50%, which is very elevated. The findings suggest that there may be a significant increase in the extracellular volume due to diffuse fibrosis, inflammation, or infiltration. Cardiac PET may be helpful to determine if these findings are secondary to an inflammatory process.3. Normal size right ventricle with moderately reduced systolic function (EF 34%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.