41 year old woman with history of Hodgkin's lymphoma, s/p chemo-radiation therapy, with recent dyspnea with exertion and chest pain, referred for stress MRI for further evaluation. MEDICATIONS: albuterol, famciclovir, synthroid First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 156 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 73 ml (normal range 31+/-10), the LV mass index is 30 g/m2, and the LV mass is 61 g. There are no regional wall motion abnormalities present. No intracardiac thrombus is present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 123 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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 trace pericardial effusion.Extracardiac FindingsThere is a 5.4cm x 5.2cm circular lesion in the mid body of the spleen. It is primarily iso-intense with surrounding tissue, with some small areas of T2 hyperintensity. It appears to be a soft tissue lesion, rather than a splenic cyst. Dedicated abdominal MRI imaging is recommended for further evaluation . There is high signal in the bilateral superior paramediastinum suggestive of radiation fibrosis with traction bronchiectasis. T
1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low normal systolic function (LVEF 53%).4. Normal RV size and systolic function (RVEF 57%).5. Further evaluation with a splenic lesion with dedicated abdominal MRI recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.