Pelvic Oncology MRI Reporting Checklist

A pelvic oncology MRI report should provide the anatomic relationships that change surgery and treatment, not merely repeat the tumor name. Organ-specific staging systems differ, but size, wall or stromal invasion, adjacent organs, pelvic sidewall, nodes, and distant spread require a fixed review in every case.

Cervical, endometrial, rectal, bladder, and adnexal cancers are not staged with one protocol. Small-field high-resolution T2 planes are tailored to the target organ. Diffusion and enhancement support but do not replace morphology.

Assessment framework

• State the primary organ, subsite, and three-plane tumor dimensions.
• Assess the organ-specific barrier, such as wall layers, stromal ring, or mesorectal fascia.
• Review ureters, bladder, rectum, vagina, prostate, seminal vesicles, and pelvic sidewalls.
• Record nodal station, short axis, morphology, and diffusion together.
• Survey peritoneum, bones, and visible upper abdomen for metastatic disease.

What the report should contain

• Use separate wording for contact, suspected invasion, and definite invasion.
• Measure the nearest surgical margin or fascial distance when relevant.
• State obstructive hydronephrosis and vascular or neural involvement.
• After treatment, compare viable-appearing tumor with fibrosis.
• Assign a stage only when the required anatomy is complete and the system applies.

Common errors

• Applying one staging checklist to every pelvic cancer.
• Treating diffusion brightness as viable tumor by itself.
• Calling every small node benign and every large node metastatic.

Example report wording

Example impression: A 36 mm cervical mass has nodular extension into the left parametrium. There is no bladder or rectal wall invasion. The left distal ureter is encased with mild hydroureter. A round, irregular 11 mm short-axis left obturator node is suspicious for metastasis. Multidisciplinary gynecologic oncology review is appropriate for treatment planning.

Return to the pelvic MRI protocol guide for the core examination technique.

References

1. American College of Radiology. Practice Parameter for MRI of the Soft-Tissue Components of the Pelvis. Source (opens in a new tab)
2. American College of Radiology. Practice Parameter for CT of the Abdomen and Pelvis. Source (opens in a new tab)

Clinical note: This material is for radiology education. Do not generate an automatic diagnosis or management decision without checking guideline scope, patient factors, and local policy.