47 year old man with history of chest pain and non-sustained ventricular tachycardia in March 2016, diagnosed with myocarditis by cardiac MRI, returns for repeat MRI to evaluate scar burden and ventricular function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 137 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 58 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 106 g (normal range 164+/-36). There are no regional wall motion abnormalities present. On T2 STIR imaging, there is no focal increase in uptake to suggest myocardial edema, and the previously seen hyperintense signal in the inferolateral and lateral walls has resolved. There is persistent late gadolinium enhancement in the basal inferior and inferolateral walls, and the mid inferolateral and anterolateral walls. There is subendocardial and epicardial involvement in this distribution, with preserved wall thickness and wall motion. While this is atypical for myocardial infarction, cannot rule out a previous circumflex embolic event. Overall there is lower intensity signal of late gadolinium enhancement when compared to the previous study, which suggests mild interval improvement of underlying fibrosing, infiltrative, or inflammatory process. Native T1 myocardial relaxation time is within normal limits (<1050ms).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 148 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).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.AortaThere is a left sided aortic arch with a bovine 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 upper normal (29mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.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. The left ventricle is normal in size with normal systolic function (EF 58%). 2. There is persistent late gadolinium enhancement in the basal inferior and inferolateral walls, and the mid inferolateral and anterolateral walls. There is subendocardial and epicardial involvement in this distribution, with preserved wall thickness and wall motion. While this is atypical for myocardial infarction, cannot rule out a previous circumflex embolic event. Overall there is lower intensity signal of late gadolinium enhancement when compared to the previous study, which suggests mild interval improvement of underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function (EF 52%).When compared to the previous study of March 8, 2016, the biventricular function is unchanged. There is no longer evidence of acute myocardial edema on T2 STIR imaging. Late gadolinium enhancement persists in the basal to mid inferolateral/anterolateral wall distribution but is of lower intensity signal. There is no evidence of pericardial inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.