Imaging plays an essential role in the evaluation and management of cardio-renal syndromes (CRS), offering key information on the structural, functional and molecular alterations involved in the bidirectional interaction between the heart and kidneys. Conventional tools, such as echocardiography and renal and vascular ultrasound, remain fundamental, allowing for real-time assessment of ventricular function, systemic congestion and renal perfusion. However, the complexity of CRS has compelled the development of more advanced imaging techniques, capable of detecting subtle and early changes that precede apparent organ failure (Lin L, Zhou X, Dekkers IA, Lamb HJ. J Pers Med 11(8):734, 2021). Cardiac magnetic resonance (MRC) allows for a precise tissular characterization, myocardial fibrosis, edema and inflammation quantification, while renal magnetic resonance imaging (MRI) offers a noninvasive evaluation of renal perfusion. Computed tomography (CT) and nuclear imaging further contribute by identifying vascular calcifications, perfusion deficits and markers of inflammation or fibrosis (Lin L, Zhou X, Dekkers IA, Lamb HJ. J Pers Med 11(8):734, 2021; Jia X, Han X, Wang Y, He F, Zhou X, Zheng Y, et al. Front Cardiovasc Med 9:1053122, 2022; Francis ST, Selby NM, Taal MW. Am J Kidney Dis 82(4):491–504, 2023). Hybrid systems like positron emission tomography (PET)-CT or PET-MRI close the gap between anatomical and functional imaging, allowing concurrent assessment of multi-organ involvement. Beyond its diagnostic purpose, imaging can introduce biomarkers for risk stratification and treatment selection and monitoring (Cantoni V, Green R, Acampa W, Assante R, Zampella E, Nappi C, et al. J Nucl Cardiol 29(1):141–154, 2022). As artificial intelligence evolves, integrating multimodal imaging data with clinical and biochemical parameters will open new pathways, providing insight not only for a more accurate diagnosis of CRS but also into prognosis and clinical management.