68 years old female, with a history of multiple myeloma. She was referred for cardiac MRI to rule out cardiac amyloid. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 48 g/m2 (normal range 67+/-11), and the LV mass is 101 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is large patch of late gadolinium enhancement noted in mid inferior wall. It spares the endocardium and the pattern is atypical for prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern of late gadolinium enhancement is also not typical of amyloidosis since it is not circumferential and it is not associated with a significant abnormality in gadolinium "kinetics." However, approximately 10% of amyloid cases have been associated with atypical late gadolinium enhancement patterns. Little is known about the pattern of late gadolinium enhancement in early cardiac amyloidosis. The differential diagnosis for this patient also includes but is not limited to myocarditis and other infiltrative processes such as sarcoidosis.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 74 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is not well evaluated due to significant respiratory artifact.Mitral ValveThe mitral valve is not well evaluated due to significant respiratory artifact.Pulmonic ValveThe pulmonic valve is not well evaluated due to significant respiratory artifact.Tricuspid ValveThe tricuspid valve is not well evaluated due to significant respiratory artifact.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Pulmonary ArteryThe main pulmonary artery is moderate to severely dilated (40mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter is noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is iron in the spleen. Consolidation is noted of the left and right lower lungs. There is trace pleural effusion. 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 and systolic function (LVEF 62%). There is large patch of late gadolinium enhancement noted in mid inferior wall which is not consistent with prior myocardial infarction. It suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. Although the pattern of late gadolinium enhancement is not typical of amyloidosis, little is known about the late gadolinium enhancement pattern that would be expected in early cardiac amyloidosis. The differential diagnosis for this late gadolinium enhancement pattern also includes, but is not limited, to myocarditis and other infiltrative processes such as sarcoidosis. Unfortunately, the location of the late gadolinium enhancement is in a place that the yield of an endomyocardial biopsy would be low. Repeat cardiac MRI in 6 months to assess for change may help further determine the etiology of the late gadolinium enhancement.2. The right ventricle is normal in size and function.3. Mild left atrial dilation.4. Moderate to severe dilation of the main pulmonary artery.5. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.