69 year old man with history of smoldering myeloma and recent diagnosis of renal amyloidosis (AL type), currently under evaluation for autologous stem cell transplant candidacy. He was referred for cardiac MRI to evaluate for possible cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 68 g/m2 (normal range 85+/-15), and the LV mass is 141 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is mild-moderate asymmetric left ventricular hypertrophy (septal thickness 12-13mm; posterior wall thickness7mm). Within the hypertrophied segment, the native myocardial T1 relaxation time is mildly elevated (1105ms). In the remainder of the myocardium, the native myocardial T1 relaxation time is within normal limits. There is late gadolinium enhancement in a "mid-wall stripe pattern" involving the basal inferior wall which is atypical for infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The extracellular volume fraction is elevated at 46% (normal 20-30%), which speaks to a diffuse infiltrative or fibrotic process. However, the gadolinium kinetics are not suggestive of overt cardiac amyloidosis. Left AtriumThe left atrium is moderate-severely dilated. The interatrial septum is aneurysmal.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 204 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely with no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is posterior mitral annular calcification.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. There is mild atherosclerosis in the descending aorta. 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 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 normal systolic function (LVEF 62%) with evidence of asymmetric hypertrophy. 2. There is late gadolinium enhancement in a "mid-wall stripe pattern" involving the hypertrophied basal inferior wall. This pattern is not consistent with prior myocardial infarction. The finding suggests the presence of an underlying infiltrative or inflammatory process. There is additionally a focal area of increased myocardial T1 relaxation time within the hypertrophied segment. This regional variation in hypertrophy and T1 relaxation time is not classically seen in cardiac amyloidosis and may rather represent an another infiltrative process such as myocarditis, sarcoidosis, etc. However, there is significant global increase in extracellular volume fraction, which raises the possibility that these findings may potentially represent early cardiac amyloidosis. 3. The right ventricle is normal in size with normal systolic function (RVEF 54%).4. Moderate posterior mitral annular calcification. 5. Biatrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.