Tehran University of Medical Sciences Basic & Clinical Cancer Research 2228-6527 15 4 2025 02 03 245 258 Behnaz Moradi Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran Masoumeh Gity Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran Sara Hassani Hospital of the university of Pennsylvania, Philadelphia, Pennsylvania Mobin Azami Student Research committee, Kurdistan University of Medical Sciences, Sanandaj, Iran Maryam Rahmani Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran Fahimeh Azizi Nik Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran Arash Khameneh Bagheri Shahid Beheshti University of Medical Sciences, Shohadaye Tajrish Hospital,Tehran, Iran Shirin Yaghoobpoor Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hamed Ghorani Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Science, Tehran, Iran 2024 01 21 2024 09 04 Background: Endometriosis is a benign gynecologic condition that is estrogen-dependent. Malignant transformation is one of the complications of endometriosis; it can affect the woman's ovarian and extra-ovarian regions. Diagnosing endometriosis-associated cancers has an essential role in treatment. Purpose: Our study aimed to review magnetic resonance imaging (MRI) features of malignant transformation of pelvic endometriosis. Material and Methods: We searched three online databases including Web of Science, Scopus, and PubMed, applying relevant keywords up to May 2022. We included English articles reporting MRI features of pelvic endometriosis pointing to malignant transformation. Results: Totally eight papers were included as they matched our inclusion requirements. Eighty-seven individuals were included finally. Studies were published between 1992 and 2021. The larger size of the lesion, loss of T2-weighted images shading, mural nodules, mural nodules contrast enhancement, and mural nodules protruding from the cyst wall at acute angles were the main MRI features suggesting potential malignant transformation of pelvic endometriosis. Conclusion: The endometriosis's malignant changes can be observed on MRI. The predominant MRI findings are a large cyst, loss of shading on T2-weighted imaging, mural nodules enhancement, and acutely angled protrusion of mural nodules from the cyst wall. https://bccr.tums.ac.ir/index.php/bccrj/article/view/516