Abstract: Middle compartment defects, a common subtype of pelvic floor dysfunction (PFD), are primarily characterized by the prolapse of the uterus or vaginal vault. Magnetic resonance imaging (MRI) has emerged as a valuable diagnostic tool for PFD, offering superior soft tissue resolution while eliminating exposure to ionizing radiation. This review comprehensive summarizes current applications of MRI in the diagnosis and treatment of PFD, covering measurement methods, manifestations of three-level structural defects, postoperative efficacy evaluation, vaginal axial assessment, and evaluation of the mesh status. The authors suggest that MRI enables precise preoperative evaluation of three-level defects, thereby facilitating the development of personalized treatment plans. Additionally, MRI provides an accurate postoperative assessment of surgical outcomes and mesh status, offering a new basis for postoperative assessment. MRI demonstrates unique value in the diagnosis and treatment of middle compartment defects.