77 year old man with history of metastatic rectal cancer s/p surgery and chemotherapy, as well as LV dysfunction who was referred for cardiac MRI for quantification of cardiac volumes and function. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 146 ml/m2 (normal range: 74+/-15), the LVEDV is 297 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 196 ml (normal range 47+/-19), the LV mass index is 80 g/m2 (normal range 85+/-15), and the LV mass is 163 g (normal range 164+/-36). There is thinning of the basal and mid inferior and inferolateral walls with associated akinesis. There is late gadolinium uptake in these segments which is transmural, and suggestive of previous infarction. These segments are not likely to be viable. The remainder of the myocardium is free of late gadolinium enhancement and is viable. No evidence of myocardial iron overload.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 210 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace 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 mildly dilated (ascending aorta 40mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is an SVC catheter. 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. Severely dilated left ventricle with moderate-severely reduced systolic function (LVEF 34%). There is akinesis of the basal and mid inferolateral and inferior walls. These walls have a transmural myocardial infarction and are not likely to be viable. The remainder of the left ventricle is free of myocardial infarction and is viable. 2. Normal sized RV with normal systolic function (RVEF 57%). 3. Mild left atrial dilation. 4. Mild dilation of ascending aorta and main pulmonary artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.