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

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. Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

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J Am Coll Radiol; 2020;17(5):S113–S124. doi: https://doi.org/10.1016/j.jacr.2020.01.018. Author information Authors and Affiliations Contributions M.A.S.T., G.D and E.O.P. designed the manuscript; B.K.A. and B.G.B.T. gathered references, M.A.S.T. and E.B.C prepared the figures, L.R.T., E.A.S.B., G.D., E.O.P. provided imaging cases, M.A.S.T. wrote the main manuscript, E.O.P., U.S.T. and G.D. edited the manuscript and gave supervised guidance. All authors reviewed the manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Araújo Santana Tavares, M., Busoletto Tripode, B., Kozlowski Andreucci, B. et al. Isthmic uterine lesions: a comprehensive pictorial review of MRI features and management strategies. Abdom Radiol 50, 6076–6084 (2025). https://doi.org/10.1007/s00261-025-05037-0 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-025-05037-0