Advanced cardiac imaging in the evaluation of masses and pseudomasses of the heart: a comprehensive MRI and dual-energy CT review

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.