67 year old woman with possible sarcoidosis, referred for evaluation of cardiac involvement and interval changes since prior CMR. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 146 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 124 g (normal range 114+/-24). There is moderate concentric left ventricular hypertrophy (13mm). There is hypokinesis of the apical inferior wall and the mid anterior wall. There is late gadolinium enhancement that is multifocal and patchy, that is atypical for an infarct pattern. It is present in the apical inferior and lateral walls, basal inferior, inferoseptal, and inferolateral walls, and basal to mid antero wall. There is additionally evidence of early gadolinium enhancement involving the apical inferior and lateral walls. Together these findings support the presence of acute or subacute myocardial inflammation. The overall LGE burden since prior MRI in 2013 has increased. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 67 ml (normal range 35+/-13). 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 mild 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. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion is noted.Extracardiac FindingsPulmonary opacities noted, please see dedicated chest CT imaging for further description. 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 low normal systolic function. Regional wall motion abnormalities as described above are noted. The overall LV ejection fraction is 51%.2. There is extensive late gadolinium enhancement which is associated with early gadolinium enhancement. These findings support the presence of acute or subacute myocardial inflammation. The pattern of late gadolinium enhancement is not typical for prior myocardial infarction. The extent of late gadolinium enhancement has increased when compared to the prior study from 2013. Given the associated lung findings, the diagnosis of cardiac sarcoidosis should be considered. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.4. Small pericardial effusion. 5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.