47 year old woman with history of abnormal nuclear scan, LV dysfunction, stroke and previously suspected LV thrombus who presents for cardiac MRI. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 168 ml/m2 (normal range: 65+/-11), the LVEDV is 382 ml (normal range 109+/-23), the LV end systolic volume index is 136 ml/m2 (normal range 18+/-5), the LVESV is 309 ml (normal range 31+/-10), the LV mass index is 47 g/m2 (normal range 67+/-11), and the LV mass is 106 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is a small rounded thrombus in the apex of the left ventricle . There is late gadolinium enhancement in the mid-inferior wall and basal anterior wall suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The late gadolinium enhancement involves the endocardial surface so the pattern is typical for prior myocardial infarction. The native T1 myocardial relaxation time is mildly 1101ms, which is abnormal. Left AtriumThe left atrium is severely dilated. The interatrial septum is bowed to the right, suggestive of elevated left atrial pressure.Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 258 ml (normal range 110+/-24), the RV end systolic volume index is 91 ml/m2 (normal range 22+/-8), and the RVESV is 206 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve leaflets are tethered and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate 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 mildly dilated.Venous AnatomyThe SVC and IVC and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are multiple large hepatic cysts noted. There is a substernal thyroid tissue on the right. 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 severely dilated with severely reduced systolic function. The overall LV ejection fraction is 19%. 2. The right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 20%. 3. There is a small rounded apical thrombus in the left ventricle. 4. There is \late gadolinium enhancement in the mid-inferior wall which is suggestive of underlying fibrosis, inflammation or infiltration. The pattern is typical for small myocardial infarctions because the late gadolinium enhancement involves the endocardium.5. There is moderate mitral regurgitation. 6. There is mild-moderate tricuspid regurgitation. 7. The main pulmonary artery is mildly dilated. 8. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.