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In a large skillet or Dutch oven over medium heat, cook the ground beef until browned and crumbled. Add the diced onion and sauté for 3–4 minutes, or until softened. Stir in the minced garlic and cook for an additional 30 seconds until fragrant.
Pour in the beef broth, diced tomatoes (if using), and Italian seasoning. Stir to combine, scraping up any browned bits from the bottom of the pan. Season with salt and pepper to taste.
Add the uncooked bowtie pasta to the skillet, pressing it down into the liquid to submerge it as much as possible. Bring the mixture to a boil, then reduce the heat to low and cover. Simmer for 10–12 minutes, stirring occasionally, until the pasta is tender and the liquid has thickened.
Stir in the heavy cream and grated Parmesan cheese. Cook for an additional 2–3 minutes, or until the sauce is creamy and well combined. If using optional add-ins like peas or spinach, stir them in during the last 2–3 minutes of cooking to heat through.
Taste the pasta and adjust seasoning with additional salt, pepper, or Italian seasoning as needed. Garnish with fresh parsley and extra Parmesan cheese before serving. Enjoy the creamy, cheesy goodness!