A 50 year old male with known sarcoid in the lungs, COPD and paroxysmal atrial fibrillation. He is being considered as a candidate for lung transplant and thus referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There is global hypokinesis with regional variation (the basal segments seem to be worse than the apical segments). There is no obvious late gadolinium enhancement noted to suggest an underlying fibrosing, infiltrative, or inflammatory process. However, the native myocardial T1 times is significantly increased (1,227ms), raising the possibility of diffuse interstitial fibrosis or inflammation. These findings are not diagnostic of cardiac sarcoid but might represent an early stage of involvement; cardiac PET may be helpful for further evaluation. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is normal in size (50ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 160 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.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 mild 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 (32mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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 normal in size with mildly reduced systolic function, the LVEF is 45%. The base of the left ventricle seems to be functioning worse than the apex. 2. There is no obvious late gadolinium enhancement noted to suggest an underlying fibrosing, infiltrative, or inflammatory process. However, the native myocardial T1 times is significantly increased (1,227ms), raising the possibility of diffuse interstitial fibrosis or inflammation. These findings are not diagnostic of cardiac sarcoid but might represent an early stage of involvement; cardiac PET may be helpful for further evaluation. 3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 42%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.