Simple SummaryIn the past, eye tumours were generally not assessed with magnetic resonance imaging (MRI) due to low image quality. MRI of the eye has significantly improved in the last decade and is, therefore, used more and more to visualise the tumour and surrounding structures. This review provides an overview of how MRI can be used to improve the clinical care of patients with a uveal melanoma, the most common eye tumour in adults. MRI can help in diagnosis, because it provides anatomical and biological information which cannot be attained by the conventional ophthalmic techniques. Dimension measurements on MRI are generally in agreement with ocular ultrasound, but MRI is more reliable when the tumour is located in the anterior part of the eye. Additionally, MRI can provide information about prognosis and treatment response, without performing a biopsy.AbstractConversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI’s diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI’s ability to non-invasively probe the tissue’s biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI’s 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.