A thorough knowledge of pelvic structures is vital for an accurate approach to pelvic tumours, an adequate description of pathways in fistulizing perianal disease, as well as for understanding pelvic floor dysfunctions. MRI, due to its superior soft tissue contrast and multiplanar capability, is the modality of choice for detailed anatomical delineation, offering unparalleled accuracy in preoperative assessment and facilitating appropriate treatment strategies for these challenging pathologies.