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Leiomyosarcoma (LMS) is the most common subtype of uterine sarcomas. It is a rare and aggressive tumour. The aim of the present study was to assess the performance of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT imaging in four clinical settings: initial staging, restaging, monitoring of response to therapy and post-therapy surveillance of uterine LMS.A bicentric retrospective study was carried out on a group of 21 patients with uterine LMS for whom a total of 52 PET/CT scans were available in initial staging (n=11), restaging (n=11), monitoring of response to therapy (n=17) and post-therapy surveillance (n=13). Clinical (minimum 6 months after PET/CT scan) and/or imaging follow-up and pathology were used as the reference standard.In the initial staging, the sensitivity, specificity and accuracy of PET imaging were 80, 100 and 91%, respectively. In the restaging and monitoring of response to therapy, all these indices were 100%, whereas they were lower in post-therapy surveillance at 75, 100 and 85%, respectively, because of two false-negative results. False-negative lesions were an infracentimetric lung nodule in the initial staging and a peritoneal nodule that had increased in size between two PET/CT scans in post-therapy surveillance. PET-negative lesions were all identified on the computed tomography (CT) part of the PET/CT; thus, the performances of the exam improved to 100% on taking into account the CT component of the PET/CT.PET/CT imaging has a high diagnostic yield in the initial staging and restaging of uterine LMS, but seems less sensitive in post-therapy surveillance. Evaluation of the CT part improves the sensitivity of the PET scan. Thus, PET/CT imaging should be considered in patients presenting with LMS.