59-year-old male with an ICD and history of CAD sent for CMR to assess for scar/late gadolinium enhancement. Wide-band imaging performed. Difficult images. Significant troubleshooting required at the MRI scanner. Extensive ICD artifact improved when patient was asked to lift arm above his head. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 234 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 121 ml (normal range 47+/-19). There is inferior/inferoseptal and inferolateral wall motion abnormalities which extend from the base of the heart to the apex. There is inferior/inferoseptal and inferolateral subendocardial late gadolinium enhancement extending from the base to mid myocardium. This is consistent with prior myocardial infarction and is of intermediate viability. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is difficult to quantify on short-axis views due to pacemaker artifact but visually appear normal in size with normal systolic function. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve could not be assessed due to ICD artifact. .Mitral ValveThe mitral valve could not be assessed due to ICD artifact. Pulmonic ValveThe pulmonic valve could not be assessed due to ICD artifact. .Tricuspid ValveThe tricuspid valve could not be assessed due to ICD artifact. .AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsThe pulmonary veins were not well seen.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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 mildly reduced systolic function. The overall LV ejection fraction is 48%. There are inferior/inferoseptal and inferolateral wall motion abnormalities which extend from the base of the heart to the apex. There is inferior/inferoseptal and inferolateral subendocardial late gadolinium enhancement extending from the base to mid myocardium. This is consistent with prior myocardial infarction and is of intermediate viability. 2. The right ventricle is difficult to quantify on short-axis views due to pacemaker artifact but visually appear normal in size with normal systolic function.3. ICD-related artifact limited evaluation of valves.