45 year old woman with history of non-ischemic cardiomyopathy of unclear etiology with dual chamber ICD and repeated ICD shocks for VT, history of VT ablation, abnormal PET/CT referred for cardiac MRI to evaluate for etiologies of her cardiomyopathy. Pre- and post-ICD interrogation was performed. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 135 ml/m2 (normal range: 65+/-11), the LVEDV is 237 ml (normal range 109+/-23), the LV end systolic volume index is 95ml/m2 (normal range 18+/-5), the LVESV is 168 ml (normal range 31+/-10), the LV mass index is 26g/m2 (normal range 67+/-11), and the LV mass is 44 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no evidence of an iron overload state. There is extensive late gadolinium enhancement involving much of the interventricular septum in a "mid-wall stripe pattern." This finding is not typical of prior myocardial infarction and suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. Additionally, the inversion time needed to null the "normal" myocardium was significantly lower than usual suggesting that we may be underestimating the burden of late gadolinium enhancement. On T2-weighted imaging, the lateral wall had increased signal suggesting the presence of myocardial inflammation. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 53ml/m2 (normal range 69+/-14), the RVEDV is 92ml (normal range 110+/-24), the RV end systolic volume index is 20 ml/m2 (normal range 22+/-8), and the RVESV is 35ml (normal range 35+/-13). An ICD lead is noted in the right ventricle.Right AtriumThe right atrium is not well seen.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is posterior mitral leaflet tethering with at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well seen.Tricuspid ValveThe tricuspid valve is not well seen.AortaThere is a left sided aortic arch with a likely normal brachiocephalic branching pattern. The aortic root is grossly normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is grossly normal in size. Venous AnatomyIntracardiac device leads are seen in the SVC. The SVC and IVC drain normally into the right ventricle.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a defibrillator can present with associated artifact. There are trivial bilateral pleural effusions. 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. Severe left ventricular dilation with severely reduced systolic function (LVEF 29%) with extensive late gadolinium enhancement involving much of the interventricular septum in a "mid-wall stripe pattern." This finding is not typical of prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Additionally, the inversion time needed to null the "normal" myocardium was significantly lower than usual suggesting that we may be underestimating the burden of late gadolinium enhancement. On T2-weighted imaging, the lateral wall had increased signal suggesting the presence of myocardial inflammation. Taken together with the patient's cardiac PET results, these findings support the diagnosis of sarcoidosis in the acute inflammatory stage. However, the differential diagnosis is not limited to cardiac sarcoidosis.2. Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.