European Society of Urogenital Radiology (ESUR) guidelines on MR imaging prior to fertility-sparing treatments in patients with cervical, endometrial, and ovarian cancers

Abstract

Objective: To establish standardised MRI protocols and structured reporting guidelines for optimal patient selection in fertility-sparing treatments for gynaecological cancers.

Methods: The European Society of Urogenital Radiology (ESUR) Female Pelvis Working Group utilised the RAND-UCLA Appropriateness Method to develop these guidelines. A multidisciplinary panel composed of ten radiologists and two gynaecological oncologists conducted a comprehensive review of clinical and imaging literature (until 28th February 2025) and evaluated MRI protocols through a structured survey consisting of 104 questions across five sections covering MR imaging preparation, equipment specifications, protocols, and reporting standards. Recommendations achieving ≥ 80% consensus were designated as "RECOMMENDED", with those below this threshold marked as "SUGGESTED" or "NOT RECOMMENDED".

Results: Consensus was reached on MRI technical requirements, including sequence selection, imaging planes, and contrast timing. Disease-specific structured reporting templates were developed with standardised criteria for cervical, endometrial and ovarian cancers.

Conclusions: These evidence-based guidelines provide a standardised framework for MRI acquisition and reporting to support optimal patient selection for fertility-sparing treatments. By harmonising imaging protocols and structured reporting, we aim to enhance diagnostic accuracy and clinical decision-making. These guidelines represent a key step toward developing comprehensive recommendations for fertility preservation, with future validation and adaptation ensuring their applicability across diverse clinical settings.

Key points: Question Fertility-sparing treatments in gynaecological cancers require adherence to strict selection criteria based on tumour stage, size, and histological subtype. Findings MRI is essential for accurately assessing eligibility criteria in cervical and endometrial cancers, and characterising adnexal masses using standardised reporting criteria. Clinical relevance MRI is valuable for the preoperative evaluation of patients considered for fertility-sparing treatments in gynaecologic cancers. Key parameters include precise tumour measurements, depth of invasion, and local tumour extent through optimised protocols combining anatomical and functional sequences.

Keywords: Endometrial neoplasms; Fertility preservation; Magnetic resonance imaging; Ovarian neoplasms; Uterine cervical neoplasms.