Simple SummaryAccording to the latest ESUR guidelines, T2WI and DWI-MR sequences are fundamental for initial staging, treatment response assessment, and evaluation of recurrence in cervical cancer, while contrast-enhanced MRI (CE-MRI) remains optional; this systematic review aims to give an overview of the literature regarding CE-MRI in cervical cancer. A total of 98 papers were included. We did not find strong evidence suggesting that CE-MRI is helpful in the clinical setting for cervical cancer staging and detection of tumor recurrence. Perfusion parameters and perfusion-derived radiomics models might have a role as a prognostic and predictive biomarker but more extensive multicentric studies with robust external validation are needed to introduce it in daily clinical practice.AbstractCorrect staging of cervical cancer is essential to establish the best therapeutic procedure and prognosis for the patient. MRI is the best imaging modality for local staging and follow-up. According to the latest ESUR guidelines, T2WI and DWI-MR sequences are fundamental in these settings, and CE-MRI remains optional. This systematic review, according to the PRISMA 2020 checklist, aims to give an overview of the literature regarding the use of contrast in MRI in cervical cancer and provide more specific indications of when it may be helpful. Systematic searches on PubMed and Web Of Science (WOS) were performed, and 97 papers were included; 1 paper was added considering the references of included articles. From our literature review, it emerged that many papers about the use of contrast in cervical cancer are dated, especially about staging and detection of tumor recurrence. We did not find strong evidence suggesting that CE-MRI is helpful in any clinical setting for cervical cancer staging and detection of tumor recurrence. There is growing evidence that perfusion parameters and perfusion-derived radiomics models might have a role as prognostic and predictive biomarkers, but the lack of standardization and validation limits their use in a research setting.