56 year old man with history of recurrent VT with dual chamber ICD, non-obstructive CAD, referred for cardiac MRI to evaluate for possible etiologies of VT. Left VentricleThere is a significant amount of artifact on cine images related to the presence of a dual chamber defibrillator but it is a diagnostic test with the following observations made: The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 125 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is extensive late gadolinium enhancement involving epicardium of the basal to mid anterolateral and inferolateral wall which is atypical for previous myocardial infarction, and suggests the presence of an infiltrative, inflammatory or fibrotic process.Left AtriumThe left atrium is moderately dilated. Right VentricleThere is a defibrillator lead in the right ventricle. The 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 72 ml/m2 (normal range 82+/-16), the RVEDV is 166 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium contains a device lead. It appears mild-moderately dilated.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 obvious pericardial disease.Extracardiac Findings 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 mildly reduced systolic function (EF 46%). There is a significant amount of artifact on the cine images related to the presence of a dual chamber defibrillator which may limit assessment of LV ejection fraction.2. There is extensive late gadolinium enhancement involving epicardium (and mostly sparing the endocardium) of the basal to mid anterolateral and inferolateral wall which is atypical for previous myocardial infarction, and suggests the presence of an infiltrative, inflammatory or fibrotic process. 3. The right ventricle is normal in size with mildly systolic function (EF 46%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.