Coronary artery disease is still a major cause of death and morbidity worldwide. In the setting of chronic coronary disease, demonstration of inducible ischemia is mandatory to address treatment. Consequently, scientific and technological efforts were made in response to the request for non-invasive diagnostic tools with better sensitivity and specificity. To date, clinicians have at their disposal a wide range of stress-imaging techniques. Among others, stress cardiac magnetic resonance (S-CMR) and computed tomography perfusion (CTP) techniques both demonstrated their diagnostic efficacy and prognostic value in clinical trials when compared to other non-invasive ischemia-assessing techniques and invasive fractional flow reserve measurement techniques. Standardized protocols for both S-CMR and CTP usually imply the administration of vasodilator agents to induce hyperemia and contrast agents to depict perfusion defects. However, both methods have their own limitations, meaning that optimizing their performance still requires a patient-tailored approach. This review focuses on the characteristics, drawbacks, and future perspectives of these two techniques.

To evaluate the possibility of reducing unnecessary biopsies in patients with BI-RADS 3 lesions by implementing Kaiser score (KS). In this retrospective, single-center study, we included 79 female patients with BI-RADS 3 lesions and risk factors who underwent biopsy following magnetic resonance imaging. Three readers (two experienced breast radiologists and a radiology resident) blinded evaluated the lesions using KS. Lesions with a KS ≤ 4 were considered benign. Results were compared with the histopathological findings (gold standard) assessing sensitivity and specificity along with 95 % confidence intervals (CI) for each reader. Inter-reader agreement was assessed using Fleiss' kappa with 95 % CIs. Moreover, Cohen's kappa was used to assess concordance between two readers at time. 79 female patients (mean age, 50.9 ± 12.2 (standard deviation)) were evaluated. The area under the receiver operating characteristic curve for the three readers was excellent: 0.99, 0.99, and 0.90), respectively. The sensitivity of the two breast radiologists and the resident was 0.92 (95 % CI: 0.62 - 0.99), 1.00 (95 % CI: 0.95 - 1.00) and 0.75 (95 % CI: 0.42 - 0.95), respectively, while the specificity was 1.00 (95 % CI: 0.95---1.00), 0.99 (95 % CI: 0.92 - 1.00), and 1.00 (95 % CI: 0.95 - 1.00) respectively. By using a KS ≤ 4 value to indicate benignity, 66 to 67 biopsies (84 to 85 % of all the biopsies) would have been avoided. Inter-reader concordance via Fleiss' kappa was 0.792 (95 % CI: 0.68 - 0.91). The implementation of KS could have spared 84-85% of biopsies, proving to be a quick, user-friendly tool with strong inter-observer agreement and high specificity.

Purpose of the Review: In this narrative review, we focus on the latest updates on CA–AS diagnosis, the implementation of CMR, and CT in the diagnostic algorithm and their future prospectives. Recent Findings: Aortic stenosis (AS) is the most common valvular heart disease (VHD) worldwide. In recent years, the association between Cardiac amyloidosis (CA) and AS has emerged as a not uncommon and sneaky association. Trans-thyretin (TTR) and immunoglobulin light chain (AL) are the two most common different types of misfolded amyloid proteins infiltrating the heart. AS–CA shares some anatomical features with CA, but the association leads to worse outcome. Nearly 30% of patients undergoing TAVR suffers from CA. Differentiating CA–AS from lone AS is of great importance to tailorize pharmaceutical therapy and/or surgery. Nowadays, bone scintigraphy and urine/serum analyses are crucial to assess which type of amyloid excess there is, but to represent anatomical changes of the myocardium cardiac magnetic resonance (CMR) and computed tomography cardiac angiography (CTCA), they are the best non-invasive tools. Moreover, extracellular expansion can be quantified via CMR, but new promising studies assessing extracellular volume (ECV) via CT are emerging. Furthermore, AS–CA is a sneaky pathology afflicting elderly patients. Seen the comorbidities of the typical patient, Transcatheter Aortic Valve Replacement (TAVR) should be the indicated procedure. CT is the best imaging modality for TAVR planning with its excellent anatomical resolution. Summary: CMR and CT could be integrated in the CA algorithm. Both can assess myocardium anatomical changes. Moreover, ECV is a precious tool to suggest the presence of amyloid in the myocardium.

Background: Distinguishing and evaluating the incidence and impact of contrast-enhanced mammography (CEM) artifacts and pitfalls can be challenging. The purpose of this study is to comprehensively analyze the frequency of CEM’s artifacts and compare the detection rates between two operators with differing experience levels. Methods: Between January 2020 to December 2023, we conducted a retrospective review of 201 patients who underwent CEM. We evaluated patient-related artifacts, contrast agent-related artifacts, technical artifacts and pitfalls, estimating the incidence of each. CEM evaluations were carried out by a senior breast radiologist with 30 years of experience [Master (M)] and a radiology resident with 1 year of training in breast radiology [Alumn (A)]. Interobserver agreement was measured using Cohen’s Kappa coefficient, and overall concordance was further assessed through Spearman’s rank correlation analysis. Results: Two hundred and one female patients with a mean age of 58.03 years (standard deviation ±12.29 years) were enrolled. The incidence of patient-related artifacts was higher for A compared to M (6.5% vs. 0.5%). The incidence of contrast agent-related artifacts was higher for M compared to A (1% vs. 0.5%). Concerning technical artifacts, in skin line artifacts the incidence was higher for A than M (65.2% vs. 43.8%) and in negative contrast enhancement artifacts the incidence was higher for M than A (47.8% vs. 14.9%). Among pitfalls, the widest range of percentage variability was seen in blind areas on CEM and in false positive benign lesions where A showed higher incidence compared to M (27.4% vs. 2% and 20.9% vs. 13.4%, respectively). Conclusions: This study highlights the high frequency and variability of CEM artifacts, particularly technical and interpretative ones, with detection rates differing notably by reader experience. Less experienced readers tended to overidentify skin line artifacts and blind areas. These findings emphasize the need for standardized training and interpretation protocols to improve diagnostic consistency in CEM.