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Endometrial Stromal Sarcoma of the Uterus: Magnetic Resonance Imaging Findings Including Apparent Diffusion Coefficient Value and Its Correlation With Ki-67 Expression
  1. Hai Ming Li, MD*,,
  2. Jia Liu, MD,
  3. Jin Wei Qiang, MD, PhD*,
  4. Wei Yong Gu, MD§,
  5. Guo Fu Zhang, MD, PhD and
  6. Feng Hua Ma, MD, PhD
  1. * Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai;
  2. Department of Radiology, Nantong Cancer Hospital, Nantong University, Nantong, Jiangsu; and Departments of
  3. Radiology, Obstetrics & Gynecology Hospital,
  4. § Pathology, Obstetrics & Gynecology Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
  1. Address correspondence and reprint requests to Jin Wei Qiang, MD, PhD, Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, 1508 Longhang Rd, Shanghai 201508, China. E-mail: dr.jinweiqiang{at}


Objective This study aimed to investigate the conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) features of endometrial stromal sarcoma (ESS) including a preliminary investigation of the correlation between the apparent diffusion coefficient (ADC) value and Ki-67 expression.

Methods The clinical and MRI data of 15 patients with ESS confirmed by surgery and pathology were analyzed retrospectively. The conventional MR morphological features, signal intensity on DWI, ADC value (n = 14), and clinicopathological marker Ki-67 (n = 13) were evaluated.

Results Of 15 patients with ESS, 13 tumors were low-grade ESS (LGESS), and the remaining 2 were high-grade ESS (HGESS); 9 tumors were located in the myometrium, 5 were located in the endometrium and/or cervical canal, and 1 was located in extrauterine. Thirteen (87%) of 15 tumors showed a homo- or heterogeneous isointensity on T1-weighted imaging and a heterogeneous hyperintensity on T2-weighted imaging. The hypointense bands were observed in 11 tumors (73%) on T2-weighted imaging. The degenerations (cystic/necrosis/hemorrhage) were observed in 7 LGESS tumors and 2 HGESS tumors. The DWI hyperintensity was observed in 13 tumors (93%) and isointensity in remaining 1. The mean ADC value of the solid components in 14 ESSs was (1.05 ± 0.20) × 10−3mm2/s. The contrast-enhanced MRI showed an obvious enhancement in 14 tumors (93%) (heterogeneous in 7 LGESSs and 2 HGESSs; homogeneous in 5 LGESSs). The ADC value was inversely correlated with the Ki-67 expression (r = −0.613, P = 0.026).

Conclusions Patients with ESS showed some characteristics on conventional MRI and DWI, and there was an inverse correlation between the ADC value and Ki-67 expression.

  • Endometrial stromal sarcoma
  • Magnetic resonance imaging
  • Diffusion-weighted imaging
  • Apparent diffusion coefficient
  • Ki-67

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  • The authors declare no conflicts of interest.