61 year old man with history of hypertension and non-ischemic cardiomyopathy referred for cardiac MRI to evaluate for etiologies of CM as well as cardiac volumes. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 55 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 50 g/m2 (normal range 85+/-15), and the LV mass is 100 g (normal range 164+/-36). There is global hypokinesis. There is a small focus of late gadolinium enhancement in the mid inferior wall, at the insertion point of the right ventricle. This is atypical for myocardial infarction, and can be observed in pulmonary hypertension or nonspecific cardiomyopathy. There is otherwise no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1190-1200ms. In the absence of significant late gadolinium enhancement, this elevated T1 value suggests the presence of at least mild underlying diffuse fibrosis or infiltration.There is [no evidence for]myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).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.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 no pericardial effusion.Extracardiac FindingsT2* imaging is suggestive of iron overload in the spleen and liver (T2* decay time of <20ms) . 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. Normal size left ventricle with moderately reduced systolic function (EF 37%). No LV thrombus noted.2. There is a small focus of late gadolinium enhancement in the mid inferior wall/inferoseptum associated with the insertion point of the RV. This is atypical for myocardial infarction and can be a nonspecific finding in cardiomyopathy. Also, there is a mild-moderate elevation in the native T1 myocardial relaxation time of the septum, which suggests the presence of at least mild diffuse underlying fibrosis or infiltration.3. Normal size right ventricle with mildly reduced systolic function (EF 46%). 4. Mild biatrial dilation.5. Low signal intensity of the liver and spleen with a significantly reduced T2* decay time; would consider iron overload if clinically appropriate. There is no evidence of intracardiac iron overload, however.