The purpose of this study is to provide an overview of advanced imaging techniques for the evaluation of cardiac masses and pseudo-masses, with particular attention to computed tomography (CT) and magnetic resonance imaging (MRI). The aim is to highlight how the complementarity of these methods can optimise diagnostic accuracy and guide therapeutic choices. A systematic review of recent literature was conducted, alongside a retrospective analysis of clinical cases drawn from our clinical experience. CT acquisition protocols were examined in relation to their ability to provide high anatomical definition images, cardiac synchronisation management and the use of dual energy techniques. At the same time, MR sequences useful for distinguishing between true masses and pseudomasses were evaluated. The study showed that CT is particularly effective in anatomical definition and detection of calcifications. In contrast, MRI provides multiparametric information, which is essential for the functional and tissue characterisation of lesions. The integrated approach allows for a more accurate diagnosis, facilitating the distinction between benign, malignant and pseudo-mass lesions. The integrated approach of CT and MRI represents the ideal diagnostic strategy for the evaluation of cardiac masses, improving diagnostic accuracy and supported by standardized protocols that exploit the best of both tools, improving diagnostic accuracy and guiding the therapeutic pathway in a personalized manner.

The purpose of this study is to provide an overview of advanced imaging techniques for the evaluation of cardiac masses and pseudo-masses, with particular attention to computed tomography (CT) and magnetic resonance imaging (MRI). The aim is to highlight how the complementarity of these methods can optimize diagnostic accuracy and guide therapeutic choices. A systematic review of recent literature was conducted, alongside a retrospective analysis of clinical cases drawn from our clinical experience. CT acquisition protocols were examined in relation to their ability to provide high anatomical definition images, cardiac synchronization management and the use of dual energy techniques. At the same time, MR sequences useful for distinguishing between true masses and pseudomasses were evaluated. The study showed that CT is particularly effective in anatomical definition and detection of calcifications. In contrast, MRI provides multiparametric information, which is essential for the functional and tissue characterization of lesions. The integrated approach allows for a more accurate diagnosis, facilitating the distinction between benign, malignant and pseudo-mass lesions. The integrated approach of CT and MRI are complementary and increasingly recognized as valuable together for the evaluation of cardiac masses, improving diagnostic accuracy and supported by standardized protocols that exploit the best of both tools, guiding the therapeutic pathway in a personalized manner.

Background: Anderson–Fabry disease (AFD) is a rare genetic disorder characterized by a deficiency of α-galactosidase A activity and the accumulation of glycosphingolipids in tissues, which leads to multiorgan damage. Cardiovascular magnetic resonance (CMR) and the T1 mapping technique are essential tools for the assessment of AFD cardiac involvement. Moreover, the T1 mapping technique has proved to be a successful non-invasive method for the early detection of patients most at risk for kidney disease. We evaluated the application of MRI in patients with AFD to assess renal involvement. Methods: We conducted a retrospective analysis of 19 patients (Group A) with histologically proven AFD who underwent routine CMR examinations for the evaluation of cardiac involvement, selecting specific sequences that also showed the left kidney, compared to a control population (Group B, 19 patients) without kidney disease. A Spearman’s rank-order correlation was run to assess the relationship between the T1 mapping values of the heart and kidney in Group A and between the kidneys of Groups A and B. Results: There was a positive correlation between the heart and kidney T1 values in Group A (rho = 0.32). More interestingly, we observed a negative correlation between the kidney values of both groups (Group A mean 1284 ± 137 ms, Group B mean 1073 ± 57 ms, rho = −0.38), which is probably related to the presence of microvascular damage and infiltrates in the kidneys of AFD patients. Conclusions: To our knowledge, these results are the first to highlight the key value of T1 mapping in assessing pathological changes and aiding in the non-invasive diagnosis of renal involvement in AFD.