17 year old man with dilated cardiomyopathy with LGE on previous CMR referred for evaluation of interval change. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 177 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 109 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is epicardial late gadolinium enhancement involving the basal to mid anterior, anterolateral, inferolateral, and inferior walls. The finding is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 125 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 68 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 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small circumferential pericardial effusion.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. Normal LV size with moderately reduced systolic function (LVEF 38%) with extensive late gadolinium enhancement as described above. There is no late gadolinium enhancement on the apical half of the interventricular septum, reducing the diagnostic yield of right ventricular endomyocardial biopsy.2. Normal RV size with mildly reduced systolic function (RVEF 47%).3. When compared to prior cardiac MRI, the LVEF is a little better but there is no significant change in the burden of late gadolinium enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.