Kubik-Huch RA, Weston M, Nougaret S, Leonhardt H, Thomassin-Naggara I, Horta M, Cunha TM, Maciel C, Rockall A, Forstner R. European Society of Urogenital Radiology (ESUR) Guidelines: MR Imaging of Leiomyomas. Eur Radiol. 2018 Aug;28(8):3125-3137. doi: 10.1007/s00330-017-5157-5. Epub 2018 Feb 28. PMID: 29492599; PMCID: PMC6028852. Abdel Wahab C, Jannot AS, Bonaffini PA, Bourillon C, Cornou C, Lefrère-Belda MA, Bats AS, Thomassin-Naggara I, Bellucci A, Reinhold C, Fournier LS. Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI. Radiology. 2020 Nov;297(2):361-371. doi: 10.1148/radiol.2020191658. Epub 2020 Sep 15. Erratum in: Radiology. 2020 Dec;297(3):E347. PMID: 32930650. Smith J, Zawaideh JP, Sahin H, Freeman S, Bolton H, Addley HC. Differentiating uterine sarcoma from leiomyoma: BET1T2ER Check!. Br J Radiol 2021; 94: 20201332.

Gynecological surgery is not free from complications and their correct diagnosis is essential for patient management.Compartmentalization of the pelvic anatomy can assist the radiologist in identifying the correct post surgical complications.

Gastric-type adenocarcinoma of the uterine cervix is an aggressive, human papillomavirus-independent subtype carrying poor prognosis, with greater propensity for metastases, and resistance to chemotherapy and radiotherapy. Distinctive MRI features of intratumoral cysts, upper endocervical location with endophytic growth, and heterogeneous enhancement which can aid in identification of GAS and differentiation from cervical squamous cell carcinoma and other benign cervical multicystic lesions. Targeted and adequate biopsy on suspicious solid areas identified on MRI is crucial for early definitive histological diagnosis. High soft-tissue resolution of MRI and the use of dedicated double-oblique imaging planes allows accurate local tumour staging. Diffusion-weighted imaging and enhancement pattern make MRI indispensable in differentiating between post-irradiation fibrosis and recurrent tumour on post-treatment follow-up.

Teaching Objectives. To review and illustrate the role of MRI in staging vulvar cancer based on the new European Society of Urogenital Radiology guidelines Review of the topic. Primary vulvar cancer is a rare tumor accounting for approximately 4% of all gynecologic malignancies. Squamous cell carcinoma (SCC) is the most usual type (>85% of all vulvar cancers). The most important prognostic factors include the size of the primary tumor and the regional lymph node status. Although imaging is not an integral part of the vulvar cancer FIGO staging, imaging performs an important role and MRI is the imaging modality of choice, according to the European Society of Urogenital Radiology(ESUR) vulvar cancer staging guidelines. Due to its superior tissue resolution, MRI is usually requested to better define the size of the tumor and its anatomic extension to the adjacent structures including the superficial (labia majora, minora, clitoris) and the deeper ones (urethra, vagina, and anus). According to the ESUR guidelines for primary tumors ≤2 cm, confined to the vulva or perineum, and with ≤1 mm of stromal invasion, imaging staging is not recommended. For local staging of SCC with stromal invasion >1 mm, tumor size >4 cm, or tumors with suspicious involvement of the urethra, vagina, or anus MRI should be performed. For tumors >2 cm and ≤4 cm, clinical staging and groin ultrasound or MRI staging are both considered valid options. For regional or locally advanced disease (FIGO stages III–IVA) or suspicious distant metastases (FIGO stage IVB),chest, abdominal and pelvic CT (or PET/CT) is recommended. Conclusion. MRI plays an important role in staging and treatment planning. Although MRI may be best suited for determining the extent of local disease and invasion, it is also helpful in identifying groin nodal metastases, which assist radiation planning.