Carcinoma ex pleomorphic adenoma is a rare malignant salivary gland tumour for which distinct radiological features are unclear. We aim to identify radiological features that may pre-operatively predict for carcinoma ex pleomorphic adenoma and its degree of invasion.

Systematic review of Ovid Medline, Embase, Scopus, Web of Science (BIOSIS), Cochrane, PROSPERO, OpenDOAR, and OpenGrey from inception to 29 April 2023. Primary outcomes of interest were radiological features in magnetic resonance imaging, computed tomography and ultrasound.

Of 1729 studies, 12 studies (n = 426) underwent qualitative synthesis. Imaging findings for magnetic resonance imaging, computed tomography, and ultrasound were reported in 11 studies (n = 337), five studies (n = 253) and one study (n = 89), respectively. Magnetic resonance imaging features of lower mean apparent diffusion coefficient values and heterogenous T2 intensity were reported.

Magnetic resonance imaging has the greatest utility in predicting for carcinoma ex pleomorphic adenoma. Within the limits, a heterogenous body of evidence, in addition to general radiologic features of malignancy, lower mean apparent diffusion coefficient values and heterogenous T2 intensity, may indicate carcinoma ex pleomorphic adenoma.