ESR Essentials: uterine cancers-practice recommendations by the European Society of Urogenital Radiology

Uterine cancers include endometrial cancer (EC), cervical cancer (CC), and uterine sarcomas, with leiomyosarcoma being the most common subtype. Each tumour type has distinct biological behaviour, imaging features, and treatment approaches. Radiologists must be familiar with normal uterine anatomy and its variations, as well as key imaging characteristics and common patterns of tumour spread to ensure accurate staging and optimal treatment selection. MRI is the imaging modality of choice for evaluating uterine malignancies due to its excellent soft tissue contrast and multiplanar capabilities. Accurate assessment requires dedicated multiparametric protocols, as recommended by the European Society of Urogenital Radiology (ESUR), including high-resolution T2-weighted imaging, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) sequences when appropriate. 18-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) complements MRI in patients with CC by providing the highest accuracy for detecting lymph-node and distant metastases. CT is mainly used for systemic evaluation. This article presents a practical guide for radiologists, describing the main clinical indications, patient preparation, and tailored MRI protocols. It also highlights key imaging findings that should be evaluated and reported. KEY POINTS: MRI is the preferred imaging modality for evaluating uterine malignancies due to its superior soft tissue contrast and multiplanar capabilities. Common clinical indications include MRI staging of endometrial and cervical cancers, assessment of eligibility for fertility preservation, and characterisation of indeterminate myometrial lesions. Adherence to established imaging guidelines is strongly recommended to ensure high-quality images as well as complete and clinically relevant radiology reports.