OBJECTIVE This study aimed to evaluate the anatomical alterations of the cardinal ligaments (CL) and uterosacral ligaments (USL) in women with uterine prolapse by magnetic resonance imaging (MRI) and MRI three-dimensional reconstruction (3DR). MATERIALS AND METHODS Forty patients with uterine prolapse and 40 volunteers with normal support underwent thin layer scan MRI. The 3D models were reconstructed with MRI data and 3D software. Origin, inserted end, geometric shape features of the CL and USL, were compared between the two groups, and the correlation in study group between the MRI and surgical dissection were reported. RESULTS In the study group, trauma was found in the USL in the insertion or origin. The dorsal USL attached to the sacrum in four (10%) patients was quite different from 12 (30%) patients of the control group. There was no significant difference in the inserted end of the USL between the two groups, nor in the origin and inserted end of the CL. In the study group, MRI and MRI 3DR better evaluated the anatomical characteristics of the USL compared to intraoperative detection via laparoscopy. DISCUSSION The approach using MRI and MRI 3DR can non-invasively detect the anatomic abnormality associated with the USL in uterine prolapsed women and can be a useful preoperative planning tool.