68 year old man with recent diagnosis of multiple myeloma and fat pad biopsy positive for amyloidosis, with hypertrophy and systolic dysfunction of the left ventricle on echocardiogram, referred for cardiac MRI to evaluate ejection fraction and for native T1 mapping. Left VentricleThe left ventricle is normal in size with moderately-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 104 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 115 g/m2 (normal range 85+/-15), and the LV mass is 185 g (normal range 164+/-36). There is global hypokinesis with severe concentric hypertrophy (septal and posterior wall thickness of 16mm). Native T1 mapping demonstrates a T1 relaxation time of 1274 ms in the septum, 1295 ms in the inferolateral wall and 1350 ms in the anterior wall. These values are highly suspicious for cardiac amyloidosis especially given the associated findings.Left AtriumThe left atrium is normal in size. The interatrial septum appears thickened.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The right ventricular wall appears thickened. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 47 ml/m2 (normal range 82+/-16), the RVEDV is 76 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 40 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. The leaflets appear thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. The leaflets appear thickenedAortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Aortic sinus of valsalva 38.7 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion mostly over the right atrium. Extracardiac FindingsThere are bilateral moderate pleural effusions (right greater than left). 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. Normal sized LV with moderate-severely reduced systolic function (EF 36%). There is severe concentric hypertrophy. 2. Normal sized RV with mildly reduced systolic function (EF 47%). 3. Small pericardial effusion and bilateral pleural effusions. 4. Interatrial septal thickening. 5. Native T1 is abnormally elevated. Taken together with the associated findings cardiac amyloidosis is highly suspected. Endomyocardial biopsy could be considered for confirmatory diagnosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.