MRI in Gynaecological Malignancies: Diagnostic challenges, pearls and pitfalls -A Pictorial Review

MRI plays a pivotal role in staging gynaecological malignancies owing to its superior soft tissue contrast and assessment of loco-regional disease. For accurate diagnosis and staging of gynaecological malignancies, meticulous image acquisition and skilled interpretation play a crucial role. Hormone-dependent physiological changes and associated benign lesions can pose challenges while diagnosing and/or staging malignancies. This may result in over- or under-staging of malignancies or errors in diagnosis. This pictorial essay aims to highlight the diagnostic challenges and pitfalls encountered while imaging various gynaecological malignancies on MRI. We discuss how advanced MRI sequences, such as diffusion-weighted imaging (DWI), Dynamic contrast-enhanced 3D sequences (DCE), and a comprehensive interpretation of all acquired sequences, aid in overcoming these challenges. Meticulous image acquisition, multiparametric imaging, including DWI and dynamic contrast-enhanced sequences, and knowledge of likely pitfalls and tumour mimics aid in improving diagnostic accuracy while reporting gynaecological malignancies.