47 year old man with history of AL type amyloidosis with systemic and cardiac involvement, who underwent chemotherapy and stem cell transplant in 2014, now referred for serial cardiac MRI to monitor his cardiac involvement. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is severe left ventricular hypertrophy (IVSd=14mm and PWd=18mm, which is stable compared to the previous study). The overall LV ejection fraction is 48%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 170 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 86 g/m2 (normal range 85+/-15), and the LV mass is 181 g (normal range 164+/-36). There is hypokinesis of the basal segments with relative preserved wall motion of the apical segments. There is persistent subendocardial to mid-myocardial late gadolinium enhancement which involves the entirety of the left ventricle, with predominance in the basal anterolateral, basal inferior and basal-mid inferolateral walls. The native myocardial T1 relaxation time is 1195ms in the mid-ventricle segments, which is decreased from prior (1250ms). Taken together, these findings are consistent with cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 55 ml/m2 (normal range 31+/-9), and the RVESV is 115 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation. Mitral ValveThe mitral valve opens widely with mild thickening of the leaflet tips, and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial 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 drain normally into the right atrium.PericardiumNo significant pericardial disease.Extracardiac FindingsThere are multiple small rounded lesions within the hepatic parenchyma which are iso in comparison to the blood pool and likely represent hemangiomas vs. cysts. 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 LVEF is 48%). There is severe concentric hypertrophy which is stable.2. There is diffuse circumferential late gadolinium enhancement involving the entirety of the left ventricular endocardium in a pattern which is unchanged from the previous study. The native myocardial T1 is elevated, but slightly reduced when compared to the previous study of February 2016. 3. The right ventricle is normal in size with mildly reduced systolic function (RVEF is 39%). This has decreased when compared to the previous study.4. The left and right atrium are moderately dilated. 5. There is mild aortic regurgitation.Overall there is evidence of worsening biventricular function with stable native T1 myocardial relaxation, stable wall thickness and late gadolinium enhancement burden. 