A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.

Background/Objectives: Hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) is an emerging imaging modality that combines metabolic and anatomical data in a single session, offering promising diagnostic performance in various cardiac conditions. However, its role in inflammatory cardiac diseases (ICDs), such as myopericarditis and endocarditis, remains underexplored. This study aims to evaluate the diagnostic value of PET/MRI in ICDs through a systematic review of the literature, complemented by our institutional experience. Methods: We conducted a systematic review of PubMed, Scopus, and Embase up to April 2025, using keywords including “PET/MRI,” “PET/MR”, “myocarditis”, “endocarditis”, “pericarditis”, “inflammatory heart disease”, and “inflammatory cardiac disease”. Studies reporting the use of hybrid PET/MRI in ICDs were included and analyzed. Additionally, we retrospectively reviewed clinical and imaging data from 33 consecutive patients who underwent PET/MRI in our center for suspected myopericarditis or endocarditis between September 2022 and March 2025. Results: The systematic review identified 12 eligible studies evaluating PET/MRI in ICDs, highlighting its added value in cases with inconclusive findings on standalone MRI or PET. Common advantages reported included improved localization of active inflammation, better characterization of tissue damage, and enhanced diagnostic confidence. In our cohort, hybrid PET/MRI was considered diagnostically useful in 16/21 (76%) of myopericarditis cases and 9/12 (75%) of endocarditis cases, particularly for reclassifying uncertain findings and guiding clinical management. Conclusions: The combined analysis of the current literature and real-world clinical experience supports the diagnostic utility of hybrid PET/MRI in the evaluation of ICDs. This multimodal approach improves the interpretation of equivocal cases, facilitates accurate diagnosis, and may influence therapeutic decisions. However, larger prospective studies are needed to confirm these findings and establish standardized protocols.

The application of cardiac magnetic resonance (CMR) imaging in clinical practice has grown due to technological advancements and expanded clinical indications, highlighting its superior capabilities when compared to echocardiography for the assessment of myocardial tissue. Similarly, the utilization of implantable cardiac electronic devices (CIEDs) has significantly increased in cardiac arrhythmia management, and the requirements of CMR examinations in patients with CIEDs has become more common. However, this type of exam often presents challenges due to safety concerns and image artifacts. Until a few years ago, the presence of CIED was considered an absolute contraindication to CMR. To address these challenges, various technical improvements in CIED technology, like the reduction of the ferromagnetic components, and in CMR examinations, such as the introduction of new sequences, have been developed. Moreover, a rigorous protocol involving multidisciplinary collaboration is recommended for safe CMR examinations in patients with CIEDs, emphasizing risk assessment, careful monitoring during CMR, and post-scan device evaluation. Alternative methods to CMR, such as computed tomography coronary angiography with tissue characterization techniques like dual-energy and photon-counting, offer alternative potential solutions, although their diagnostic accuracy and availability do limit their use. Despite technological advancements, close collaboration and specialized staff training remain crucial for obtaining safe diagnostic CMR images in patients with CIEDs, thus justifying the presence of specialized centers that are equipped to handle these type of exams.

Background and Objectives: Cardiac magnetic resonance (CMR) imaging has become an essential instrument in the study of cardiomyopathies; it has recently been integrated into the diagnostic workflow for cardiac amyloidosis (CA) with remarkable results. An additional emerging role is the stratification of the arrhythmogenic risk by scar analysis and the possibility of merging these data with electro-anatomical maps. This is made possible by using a software (ADAS 3D, Galgo Medical, Barcelona, Spain) able to provide 3D heart models by detecting fibrosis along the whole thickness of the myocardial walls. Little is known regarding the applications of this software in the wide spectrum of cardiomyopathies and the potential benefits have yet to be discovered. In this study, we tried to apply the ADAS 3D in the context of CA. Materials and Methods: This study was a retrospectively analysis of consecutive CMR imaging of patients affected by CA that were treated in our center (Marche University Hospital). Wherever possible, the data were processed with the ADAS 3D software and analyzed for a correlation between the morphometric parameters and follow-up events. The outcome was a composite of all-cause mortality, unplanned cardiovascular hospitalizations, sustained ventricular arrhythmias (VAs), permanent reduction in left ventricular ejection fraction, and pacemaker implantation. The secondary outcomes were the need for a pacemaker implantation and sustained VAs. Results: A total of 14 patients were deemed eligible for the software analysis: 8 patients with wild type transthyretin CA, 5 with light chain CA, and 1 with transthyretin hereditary CA. The vast majority of imaging features was not related to the composite outcome, but atrial wall thickening displayed a significant association with both the primary (p = 0.003) and the secondary outcome of pacemaker implantation (p = 0.003). The software was able to differentiate between core zones and border zones of scars, with the latter being the most extensively represented in all patients. Interestingly, in a huge percentage of CMR images, the software identified the highest degree of core zone fibrosis among the epicardial layers and, in those patients, we found a higher incidence of the primary outcome, without reaching statistical significance (p = 0.18). Channels were found in the scar zones in a substantial percentage of patients without a clear correlation with follow-up events. Conclusions: CMR imaging plays a pivotal role in cardiovascular diagnostics. Our analysis shows the feasibility and applicability of such instrument for all types of CA. We could not only differentiate between different layers of scars, but we were also able to identify the presence of fibrosis channels among the different scar zones. None of the data derived from the ADAS 3D software seemed to be related to cardiac events in the follow-up, but this might be imputable to the restricted number of patients enrolled in the study.

Background/Objectives : Contrast-enhanced mammography (CEM) integrates morphological and functional imaging using contrast agents, making it a valuable tool in breast cancer (BC) diagnosis. In 2022, the Breast Imaging Reporting and Data System for CEM was introduced. This study aims to investigate the relationship between CEM morphodynamic features and the histopathological characteristics of BC. Methods: In this prospective study were consecutively enrolled, between December 2022 and May 2024, patients with BI-RADS 4 or 5 lesions undergoing CEM followed by surgical excision. Low-energy and recombined CEM images were analysed for breast composition, lesion characteristics, and enhancement patterns. Histopathological evaluation included tumor size, histotype, grade, lymphovascular invasion and immunophenotype. Spearman rank correlation and multivariable regression analysis were used to evaluate the relationship between CEM findings and histopathological characteristics. Results: Fifty female patients (mean age: 57.2 ± 13.7 years) and 50 BCs were analysed. Tumor dimensions observed on CEM showed a strong correlation with histopathological tumor size (ρ = 0.788, p < 0.001) and were associated with grade 3 lesions (p = 0.017). Not circumscribed margins on CEM were significantly associated with the Luminal-B (p = 0.001), while high lesion conspicuity was associated with Luminal-B and triple-negative (p = 0.001) and correlated with larger tumor size (ρ = 0.517, p < 0.001). Background parenchymal enhancement negatively correlated with patient age (ρ = -0.286, p = 0.049). Conclusions : CEM provides critical insights into BC morphology and biology, demonstrating significant relationship between imaging features and histopathological characteristics.

Contrast-enhanced mammography (CEM) combines morphological and functional imaging, enhancing breast cancer (BC) diagnosis. This study investigates the relationship between CEM morphodynamic features and histopathological characteristics of BC. In this prospective study, 50 female patients (mean age: 57.2 ± 13.7 years) with BI-RADS 4–5 lesions underwent CEM followed by surgical excision between December 2022 and May 2024. Low-energy and recombined CEM images were analyzed for breast composition, lesion characteristics, and enhancement patterns, while histopathological evaluation included tumor size, histotype, grade, lymphovascular invasion, and immunophenotype. Spearman rank correlation and multivariable regression analysis were used to evaluate the relationship between CEM findings and histopathological characteristics. Tumor size on CEM strongly correlated with histopathological tumor size (ρ = 0.788, p < 0.001) and was associated with high-grade lesions (p = 0.017). Non-circumscribed margins were linked to a Luminal-B subtype (p = 0.001), while high lesion conspicuity was associated with Luminal-B and triple-negative BC (p = 0.001) and correlated with larger tumors (ρ = 0.517, p < 0.001). Background parenchymal enhancement was negatively correlated with age (ρ = −0.286, p = 0.049). CEM provides critical insights into BC, demonstrating significant relationship between imaging features and histopathological characteristics. These findings highlight CEM’s potential as a reliable tool for tumor size estimation, subtype characterization, and prognostic assessment, suggesting its role as an alternative to MRI, particularly for patients with contraindications.