79 year old male referred for cardiovascular MRI to evaluate for cardiac amyloidosis. Left VentricleThe left ventricle is normal in size with moderate to severe concentric hypertrophy and mildly reduced systolic function. The overall LV ejection fraction is 41%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 127 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 98 g/m2 (normal range 85+/-15), and the LV mass is 188 g (normal range 164+/-36). The basal segments of the ventricle are more hypokinetic than the apical segments. The myocardium and LV cavity blood pool appear to null at near the same inversion time consistent with abnormal "gadolinium kinetics." There is diffuse nearly transmural late gadolinium enhancement which is most pronounced in the basal inferolateral wall and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. Taken together these findings are consistent with the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 39%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 52 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to 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 are normal in size and drain normally into the right atrium.PericardiumThere is a small to moderate pericardial effusion.Extracardiac FindingsBilateral pleural effusions are note (R>L). 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. Moderate to severe left ventricular hypertrophy with mildly reduced systolic function (LVEF 41%). There is evidence of abnormal "gadolinium kinetics" and diffuse late gadolinium enhancement in a pattern strongly suggestive of cardiac amyloidosis.2. Normal RV size with moderately reduced systolic function (RVEF 39%).3. Biatrial dilation.4. Small to moderate pericardial effusion.5. Bilateral pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.