50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. Normal LV wall thickness (9-10mm), which is stable compared to the last study. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the is 136 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 103 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.66, which is in the normal range. The global relative enhancement is 1.89, which is in the normal range. This study was unable to calculate native T1 relaxation time. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 128 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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.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. Fibrin sheaths in the veins of the upper mediastinum, likely related to previous intravascular lines. PericardiumThere is a small pericardial effusion which is located over the basal portion of the heart and increased compared to the prior study. There is persistent but less notable T2-STIR signal of the pericardium associated with previously noted postoperative pericarditis. Extracardiac FindingsSternal wires are present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. 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 normal in size with normal systolic function. The overall LV ejection fraction is 67%. This is unchanged compared to the previous exam.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. Wall thickness is stable. There is no late gadolinium enhancement. These findings speak against acute rejection. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%. This is unchanged compared to the previous exam. 4. Fibrin sheaths in the veins of the upper mediastinum. 5. Decreased T2-STIR signal and gadolinium enhancement of the pericardium but increase in amount of pericardial fluid.