50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. Normal LV wall thickness (9mm), which is less than the last study. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the is 142 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 61 g/m2 (normal range 85+/-15), and the LV mass is 133 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.42, which is in the normal range. The global relative enhancement is 2.9, which is in the normal range. The native myocardial T1 time in the interventricular septum is 1140ms, which is elevated and may indicate edema or fibrosis, but this value measures lower than on the previous study. The extra-cellular volume fraction (ECV) is 31%, which is elevated but decreased from previously. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is a possible SVC catheter versus laminar thrombus noted.PericardiumThere is a trivial pericardial effusion. There is increased signal in the pericardium on T2-STIR and late gadolinium imaging which suggests edema and inflammation of the pericardium, consistent with a post-surgical state. Extracardiac FindingsSternal wires are present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. 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. The overall LV ejection fraction is 65%. This is unchanged compared to the previous exam.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. These findings all speak against acute rejection. The wall thickness is now also normal. The native myocardial T1 time and the extracellular volume fraction are elevated but improving as expected in the early post-transplant period. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%. This is unchanged compared to the previous exam. 4. Possible SVC catheter versus thrombus. 5. Increased T2-STIR signal and gadolinium enhancement of the pericardium, possibly consistent with post-surgical pericarditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.