A 50 year old man with a history of ischemic cardiomyopathy, s/p heart transplant (4/30/2015) and antibody mediated rejection, hypertension and diabetes. Referred for follow-up cardiac MRI . Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 57 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There is mild abnormal septal wall motion consistent with prior sternotomy. There are no regional wall motion abnormalities present. There is focal subepicardial late gadolinium enhancement in the mid-apical inferoseptal wall. This finding suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This finding could be consistent with underlying myocarditis. The myocardial native T1 time is 1282ms (previously 1167ms on 12/11/15 and 1231ms on 12/2/15). This is elevated and can suggest the presence of an intra-myocardial process. It has increased compared to the last 2 prior MRIs. The myocardial to skeletal T2 ratio is normal (below 2).By method of disks, the cardiac output is 7.36L/min and the cardiac index is 3.83L/min/m2.By phase contrast velocity encoded imaging, the cardiac output is 6.89L/min and the cardiac index is 3.39L/min/m2.Left AtriumThe left atrium is moderately dilated (134 ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 150 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a combined right innominate and left common carotid or "pseudo bovine" branching pattern, which is a normal variant. The aortic root is normal in size (20 x 23 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size (24mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThe pericardium is thickened (5-6 mm maximal). The pericardium is bright on LGE images as well on T2-weighted imaging suggesting that it is edematous/ inflamed with possible fibrosis. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of respirophasic septal shift. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present. All these findings are similar to those found in the last MRI (12/11/2015), with the exception that contrast was given on today's study.Extracardiac FindingsSternal wires noted. 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 LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is focal subepicardial late gadolinium enhancement in the mid-apical inferoseptal wall which could represent the presence of an underlying fibrosing, infiltrative, or inflammatory process. It is not typical of myocardial infarction but could represent underlying myocarditis. 3. The myocardial native T1 time is 1282ms (higher than noted previously). This could suggest the presence of an intra-myocardial process. 4. The right ventricle is normal in size with normal systolic function, the RVEF is 53%. 5. There is thickening of the pericardium with evidence of inflammation and possible fibrosis. These findings suggest that there is ongoing pericarditis. Despite these findings, however, there is no evidence of constrictive physiology. 6. There is a small loculated pericardial effusion adjacent to the right atrium, without significant change compared to previous MRI.5. 7. The left atrium is moderately dilated. 8. The right atrium is mildly dilated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.