With the advances in imaging technology and particularly magnetic resonance imaging and spiral computed tomography, questions have been raised whether these expensive modalities are affordable and cost effective. Although individual procedures are expensive, if applied as part of a logical decision trees, with proper indications and without duplications and redundancies they can obviate hospitalization and more costly exploratory laparotomy with its increase in morbidity and mortality. However, less costly techniques like ultrasound have their place as the primary approach, and it is important to know where problem-solving CT or MR is needed. MR in particular can provide information about the type of congenital anomaly and allow then the optimal surgical approach. This can result in approximation of chances for conception, successful pregnancy and child bearing. Similarly, the distinction between adenomyosis and leiomyomas is of great importance (when uterine preservation is requested), and at present only MR can make this distinction which leads to therapeutic decisions and patient counseling. In carcinoma of the cervix, staging with MR can determine whether radical surgery or radiation therapy will be the proper treatment approach. In carcinoma of the endometrium, patients with papillary serous carcinoma, high grade lesions, and patients presenting as poor risks for surgical staging will benefit from staging with MR. Lastly, as over 40% of patients with carcinoma of the ovary are understaged at the time of initial laparotomy, imaging findings may lead to more appropriate surgical approaches. With respect to the choice of imaging, at present CT is the primary and MR is a problem-solving modality.(ABSTRACT TRUNCATED AT 250 WORDS)