58 year old female with a history of left ventricular hypertrophy referred for further evaluation with cardiac MRI. Left VentricleThe left ventricle is mildly dilated and normal in systolic function. The overall LV ejection fraction is 56%. There is concentric left ventricular hypertrophy (approximately 12-14 mm thickness in the mid septum). The LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 65 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 131 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is diffuse late gadolinium enhancement which is worst along the basal inferolateral wall. In the remainder of the ventricle is worst circumferentially around the endocardium. Additionally the inversion time of the myocardium and LV cavity blood pool are within 80ms of each other. The pre-contrast, native myocardial T1 relaxation times are elevated (1150-1200 ms) which are moderately elevated. The ECV fraction is 33%, which is elevated. There is no evidence of myocardial iron overload. Together these findings suggest the presence of an underlying myocardial infiltrative or fibrosing process and are most supportive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is severely dilated. The interatrial septum is thickened. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately 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 a small 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. The left ventricle is mildly dilated, moderately hypertrophied, but with normal systolic function (LVEF 56%). The late gadolinium enhancement pattern and other tissue characteristics most support the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size with normal in systolic function (RVEF 56%).3. Significant biatrial enlargement.4. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.