A fistula that occurs in association with a malignancy of the female reproductive tract may be caused by a primary or recurrent tumor or may be a complication of surgery or radiation therapy. Identification of the cause, complexity, and location of a fistula is essential for op�timal management planning. Radiologic imaging, particularly with computed tomography and magnetic resonance techniques, is invalu�able for the assessment of gynecologic fistulas and may help direct the clinician toward the most appropriate management pathway. The mo�dality and technique selected for the initial imaging evaluation depend largely on the clinical history and manifestations. However, imaging with a combination of techniques often is required for accurate diag�nosis and effective treatment planning. Radiologists should be familiar with suggestive clinical signs and symptoms as well as with the charac�teristic appearances of rectovaginal, vesicovaginal, ureterovaginal, en-terovesical, enterocutaneous, and other pelvic fistulas at multimodality imaging.