Multiparametric cardiovascular magnetic resonance for differentiating cardiac masses: clinical impact from a case series.

Background: Cardiac masses represent a rare but clinically significant diagnostic entity. Morphological assessment alone is often insufficient for definitive diagnosis. Cardiovascular magnetic resonance (CMR) provides comprehensive tissue characterization. Case summary: We present a case series illustrating the heterogeneous spectrum of cardiac masses encountered in both oncologic and non-oncologic patients. Clinical scenarios included intracardiac metastases, tumour-related thrombus, bland thrombi, and benign primary tumours, such as rhabdomyoma and myxoma. In all cases, CMR was pivotal for tissue characterization using multiparametric assessment. Discussion: This series highlights the limitations of morphology-based assessment and emphasizes the value of a structured multiparametric CMR approach. Key features, such as perfusion, enhancement pattern, tissue heterogeneity, and infiltrative behaviour, allow reliable differentiation between thrombi and neoplastic lesions. Beyond illustrating individual cases, this series proposes a structured multiparametric CMR algorithm applicable across diverse clinical scenarios, emphasizing its role in medical practice and diagnostic decision-making.