Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jun 7.
doi: 10.1007/s00261-025-05037-0. Online ahead of print.

Isthmic uterine lesions: a comprehensive pictorial review of MRI features and management strategies

Marília Araújo Santana Tavares  1 , Bruna Gabryela Busoletto Tripode  2 , Bruna Kozlowski Andreucci  2 , Eduarda Bezerra Cirne  2 , Elisa Almeida Sathler Bretas  2 , Lucas Rios Torres  2   3 , Eduardo Oliveira Pacheco  2   3 , Ulysses S Torres  2   3 , Giuseppe D'Ippolito  2   3
Affiliations
Review

Isthmic uterine lesions: a comprehensive pictorial review of MRI features and management strategies

Marília Araújo Santana Tavares et al. Abdom Radiol (NY). .

Abstract

The uterine isthmus, the narrowest portion of the uterus, plays an essential role in female reproductive health and can be the site of several gynecological pathologies. Due to its strategic location, lesions in this region have unique characteristics and can lead to a wide variety of symptoms and diagnostic challenges. Diagnosis is usually made through imaging tests, such as ultrasound (US) or magnetic resonance imaging (MRI), with appropriate treatment depending on the precise identification of the type of lesion and evaluation of factors such as size, location, and risk of malignancy. This pictorial essay provides a comprehensive, image-rich review of multiple uterine isthmic lesions-including isthmoceles (cesarean scar defects) and their complications, fibroids in the isthmus, cesarean scar ectopic pregnancies (CSEP), isthmic endometriosis, adenomyosis/adenomyomas, post-curettage vascular malformations, niche-related intrauterine device (IUD) malposition, trophoblastic tissue implants, and endometrial polyps-highlighting their MRI appearances, epidemiological and clinical correlations, and management options.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

References

    1. Baldini GM, Lot D, Malvasi A, et al. Isthmocele and Infertility. J Clin Med. Multidisciplinary; 2024;13(8):2192. doi: https://doi.org/10.3390/jcm13082192 . - DOI
    1. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Rev Assoc Med Bras; 2019;65(5):714–721. doi: https://doi.org/10.1590/1806-9282.65.5.714 . - DOI - PubMed
    1. Szafarowska M, Biela M, Wichowska J, et al. Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele—Preliminary Results. J Clin Med; 2021;10(13):2928. doi: https://doi.org/10.3390/jcm10132928 . - DOI - PubMed - PMC
    1. Gerkowicz SA, Fiorentino DG, Kovacs AP, Arheart KL, Verma U. Uterine structural abnormality and intrauterine device malposition: analysis of ultrasonographic and demographic variables of 517 patients. Am J Obstet Gynecol; 2019;220(2):1831–1838. doi: https://doi.org/10.1016/j.ajog.2018.11.122 . - DOI - PubMed
    1. Verest A, Borwski E, Cadron I, Van Calenbergh S, Vanspauwen R. Intrauterine device (IUD) migration in cesarean delivery scar: What to do with the niche? Facts Views Vis Obgyn. 2019;11(3):251–256. PMID: 32082532. http://www.ncbi.nlm.nih.gov/pubmed/32082532 . - PubMed

LinkOut - more resources