70 year old man with history of sarcoid (pulmonary and ocular involvement), diabetes, hyperlipidemia, with exertional dyspnea and significant hypertrophy on echocardiogram. He was referred for cardiac MR stress testing to evaluate for coronary disease and/or infiltrative cardiomyopathies. MEDICATIONS: aspirin, enalapril, lovastatin, metformin First Pass PerfusionDuring hyperemia, there is a circumferential perfusion defect involving the basal, mid, and apical slices of the left ventricle.Viability/ Myocardial ScarThere is extensive late gadolinium enhancement involving the entirety of the left ventricular subendocardium, in a pattern which is atypical for previous myocardial infarction. In addition, the inversion time for the myocardium and the LV cavity are within 80ms of each other, which is also suggestive of amyloidosis. Left VentricleThe left ventricle is severely hypertrophied (IVSd=16mm) but with normal systolic function.Left AtriumThe left atrium is moderately enlarged. The left atrial wall is thickened.Right VentricleThe right ventricle is normal size and systolic functionRight AtriumThe right atrium is moderately enlarged. The interatrial septum is thickened. 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "pseudo-bovine" brachiocephalic branching pattern. Mild thoracic and descending aorta atherosclerosis.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 FindingsBilateral upper pulmonary infiltrates noted. Trivial right effusion. Large para-aortic and subcarinal lymph nodes noted. 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. Although during hyperemia, there is significant circumferential perfusion defect involving the entire left ventricle, it is unclear if this finding is secondary to presumed cardiac amyloidosis or due to coronary artery disease.2. There is no evidence of prior myocardial infarction. 3. Severe left ventricular hypertrophy with normal systolic function. There is extensive late gadolinium enhancement in a pattern that is strongly suggestive of the diagnosis of cardiac amyloidosis rather than cardiac sarcoidosis.4. Normal RV size and systolic function.5. Moderate biatrial dilation. 6. See extra-cardiac findings. 7. Quantification of LV/RV volumes and myocardial T1 times to follow as an addendum. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.