66 year old M with HTN, history of syncope, inducible VT s/p Pacemaker, HFrEF, now with infection s/p pacemaker leads removal. Referred for MRI to assess for scar as likely etiology of VT. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. The LVEDV is 154 ml (normal range 142+/-34), the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVESV is 79 ml (normal range 47+/-19) and the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is an area of mid myocardial late gadolinium enhancement in the basal and mid anterior and septal left ventricle. This suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is within normal limits in the lateral wall and septum. It is abnormal in the area of late gadolinium enhancement (1174 ms) again suggestive of underlying diffuse fibrosis or infiltration in that region.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 145 ml (normal range 142+/-31), RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVESV is 69 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 mild 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 normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. SVC thrombus.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.Mid myocardial late gadolinium enhancement noted in the basal and mid anteroseptal and septal left ventricle. This suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is not the pattern of prior myocardial infarction.2.Native T1 myocardial relaxation time is abnormal in the region of this late gadolinium enhancement (1174 ms) again suggestive of underlying diffuse fibrosis or infiltration in that region.3.The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%.4.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. 5.SVC thrombus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.