ESUR guidelines on MR imaging prior to fertility-sparing treatments in patients with cervical, endometrial, and ovarian cancers

Sep 23, 2026

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Guidelines from the European Society of Urogenital Radiology (ESUR) establish standardised MRI protocols and structured reporting for optimal patient selection for fertility-sparing treatments in cervical, endometrial, and ovarian cancers. A multidisciplinary Female Pelvis Working Group used the RAND-UCLA Appropriateness Method and reviewed clinical and imaging literature up to 28 February 2025. MRI technical requirements, including sequences, planes, and contrast timing, reached consensus, and disease-specific structured reporting templates were developed with standardised criteria. Recommendations meeting ≥80% consensus are “RECOMMENDED”, with others graded as “SUGGESTED” or “NOT RECOMMENDED”.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

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Abstract

Key Points

Introduction

Methods

Results

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Patient preparation

Gui et al. European Radiology (2025) 35:7244–7259 [https://doi.org/10.1007/s00330-025-1](https://doi.org/10.1007/s00330-025-1)1625-x SPECIAL REPORT European Society of Urogenital Radiology (ESUR) guidelines on MR imaging prior to fertility-sparing treatments in patients with cervical, endometrial, and ovarian cancers Benedetta Gui 1, Luca Russo 1,2* , Nishat Bharwani3,4, Teresa Margarida Cunha5, Carlos Nicolau6, Carlos Carnelli7, Francesco Fanfani8,9, Denis Querleu8, Pamela Causa Andrieu 10, Yulia Lakhman 11, Stefania Rizzo 12, Evis Sala 1,2, Stephanie Nougaret 13,14 and Lucia Manganaro 15 Abstract Objective To establish standardised MRI protocols and structured reporting guidelines for optimal patient selection infertility-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 ingynaecologic cancers. Key parameters include precise tumour measurements, depth of invasion, and local tumour extent through optimised protocols combining anatomical and functional sequences. *Correspondence: Luca Russo [lucarusso.md@gmail.com](lucarusso.md@gmail.com) Full list of author information is available at the end of the article © The Author(s), under exclusive licence to European Society of Radiology 2025 Keywords Magnetic resonance imaging, Fertility preservation, Uterine cervical neoplasms, Endometrial neoplasms, Ovarian neoplasms Introduction Gynaecologic cancers have a signiﬁcant impact on premenopausal women, with age-speciﬁc (18–45 years) incidence rates for cervical, endometrial and ovarian cancers of 3.2%, 1.8%, and 2.4%, respectively, in 2022 [1, 2]. Impact of these cancers on reproductive-aged women underscores the critical need to preserve fertility without compromising oncologic outcomes, emphasising the importance of timely referral to specialists for fertility preservation counselling after cancer diagnosis [3, 4]. Incorporation of imaging information in the fertilitysparing (FS) decision process has recently been deﬁned by the European Society of Gynaecological Onco

FAQs

What is the main purpose of the ESUR guidelines in this document?

To standardise MRI protocols and structured reporting to support optimal patient selection for fertility-sparing treatments in cervical, endometrial, and ovarian cancers.

How were the guidelines developed and what method was used?

The Female Pelvis Working Group used the RAND-UCLA Appropriateness Method, including a structured survey of 104 questions and a multidisciplinary panel review of clinical and imaging literature.

What determines whether a recommendation is “RECOMMENDED”, “SUGGESTED”, or “NOT RECOMMENDED”?

Recommendations achieving at least 80% consensus are “RECOMMENDED”; those below are marked as “SUGGESTED” or “NOT RECOMMENDED”.

Sep 23, 2026

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