Variations of ADC of normal uterine zones in postmenopausal and reproductive women

Athina Tsili, Alexandra Ntorkou, Thomas Vrekoussis, Vasilios Maliakas, Maria Argyropoulou


Purpose: The aim was to establish normal values and to compare the apparent diffusion coefficient (ADC) of the uterine zones in postmenopausal and reproductive age women in the three phases of the menstrual cycle. 

Materials and Methods: This retrospective study included 194 women. All magnetic resonance imaging (MRI) examinations were performed on a 1.5 T scanner. Diffusion-weighted imaging (DWI) was performed using a single shot, multislice spin-echo diffusion planar sequence and b-values of 0 and 800 s/mm2. ADC of normal endometrium/myometrium was classified into four groups according to menstrual status: menopause, menstrual, proliferative and secretory phase. Analysis of Variance followed by the Least Significant Difference (LSD) test was used for statistical analysis. 

Results: The mean and SD (standard deviation) of ADC (×10−3 mm2/s) of the endometrium was: menopause: 1.36 ± 0.18; menstrual phase: 1.24 ± 0.22; proliferative phase: 1.38 ± 0.20; and secretory phase: 1.50 ± 0.18 (F: 12.317, P <0.001). The LSD test showed differences between menopause and menstrual phase (P: 0.020) and between menopause and secretory phase (P: 0.001), but not between menopause and proliferative phase (P: 0.643). The mean and SD (standard deviation) of ADC (×10−3 mm2/s) of the myometrium was: menopause: 1.60 ± 0.15; menstrual phase: 1.92 ± 0.28; proliferative phase: 1.72 ± 0.24; and secretory phase: 1.86 ± 0.27 (F: 16.034, P <0.001). Significant difference was observed between all phases (P < 0.05).

Conclusion: A wide variation of ADC of normal endometrium/myometrium was found between postmenopausal and reproductive age women. A standard reference of ADC of normal uterine zones is helpful, serving as a baseline when interpreting uterine diseases.

Full Text:



Bammer R. Basic principles of diffusion-weighted imaging. Eur J Radiol 2003; 45(3): 169-184.

Thoeny HC, Forstner R, De Keyzer F. Genitourinary applications of diffusion-weighted MR imaging in the pelvis. Radiology 2012; 263(2): 326-342.

Punwani S. Diffusion weighted imaging of female pelvic cancers: concepts and clinical applications. Eur J Radiol 2011; 78(1): 21-29.

Sala E, Rockall AG, Freeman SJ, et al. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: What the radiologist needs to know. Radiology 2013; 266(3): 717-740.

Sala E, Rockall A, Kubik-Huch RA. Advances in magnetic resonance imaging of endometrial cancer. Eur Radiol 2011; 21(3): 468-473.

Sala E, Rockall A, Rangarajan D, et al. The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis. Eur J Radiol 2010; 76(3): 367-385.

Inada Y, Matsuki M, Nakai G, et al. Body diffusion-weighted MR imaging of uterine endometrial cancer: Is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol 2009; 70(1): 122-127.

Rechichi G, Galimberti S, Signorelli M, et al. Myometrial invasion in endometrial cancer: Diagnostic performance of diffusion-weighted MR imaging at 1.5-T. Eur Radiol 2010; 20(3): 754-762.

Cao K, Gao M, Sun YS, et al. Apparent diffusion coefficient of diffusion weighted MRI in endometrial carcinoma-Relationship with local invasiveness. Eur J Radiol 2012; 81(8): 1926-1930.

Hori M, Kim T, Onishi H, et al. Endometrial cancer: Preoperative staging using three dimensional T2-weighted turbo spin-echo and diffusion-weighted MR imaging at 3.0 T: A prospective comparative study. Eur Radiol 2013; 23(8): 2296-2305.

Andreano A, Rechichi G, Rebora P, et al. MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: A systematic review and meta-analysis. Eur Radiol 2014; 24(6): 1327-1338.

Rechichi G, Galimberti S, Signorelli M, et al. Endometrial cancer: Correlation of apparent diffusion coefficient with tumor grade, depth of myometrial invasion, and presence of lymph node metastases. AJR Am J Roentgenol 2011; 197(1): 256-262.

Fujii S, Matsusue E, Kigawa J, et al. Diagnostic accuracy of the apparent diffusion coefficient in differentiating benign from malignant uterine endometrial cavity lesions: initial results. Eur Radiol 2008; 18(2): 384-389.

Tamai K, Koyama T, Saga T, et al. The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 2008; 18(4): 723-730.

Sato K, Yuasa N, Fujita M, et al. Clinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma. Am J Obstet Gynecol 2014; 210(4): 368.e1-8.

Thomassin-Naggara I, Dechoux S, Bonneau C, et al. How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol 2013; 23(8): 2306-2314.

Takeuchi M, Matsuzaki K, Nishitani H. Manifestations of the female reproductive organs on MR images: Changes induced by various physiologic states. Radiographics 2010; 30(4): 1147.

Lee JK, Gersell DJ, Balfe DM, et al. The uterus: In vitro MR-anatomic correlation of normal and abnormal specimens. Radiology 1985; 157(1): 175-179.

Demas BE, Hricak H, Jaffe RB. Uterine MR imaging: Effects of hormonal stimulation. Radiology 1986; 159(1): 123-126.

Haynor DR, Mack LA, Soules MR, et al. Changing appearance of the normal uterus during the menstrual cycle: MR studies. Radiology 1986; 161(2): 459-462.

Kido A, Kataoka M, Koyama T, et al. Changes in apparent diffusion coefficients in the normal uterus during different phases of the menstrual cycle. Br J Radiol 2010; 83(990): 524-528.

Tsili AC, Argyropoulou MI, Tzarouchi L, et al. Apparent diffusion coefficient values of the normal uterus: Interindividual variations during menstrual cycle. Eur J Radiol 2012; 81(8): 1951-1956.

Kuang F, Ren J, Huan Y, et al. Apparent diffusion coefficients of normal uterus in premenopausal women with 3.0-T magnetic resonance imaging. J Comput Assist Tomogr 2012; 36(1): 54-59.

He Y, Ding N, Li Y, et al. 3-T diffusion tensor imaging (DTI) of normal uterus in young and middle-aged females during the menstrual cycle: Evaluation of the cyclic changes of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values. Br J Radiol 2015;88(1049): 20150043.

Dallenbach-Hellweg G, Schmidt D, Dallenbach F. Normal endometrium. In: Dallenbach-Hellweg G, Schmidt D, Dallenbach F (eds). Atlas of Endometrial Histopathology. Berlin Heidelberg 2010; 7-44.

Dallenbach-Hellweg G. The normal histology of the endometrium. In: Dallenbach Hellweg G (ed). Histopathology of the endometrium. Berlin Heidelberg 2013; 20-76.

Jiménez-Ayala M, Jiménez-Ayala Portillo B. Cytology of the Normal Endometrium Cycling and Postmenopausal. In: Jimenez-Ayala M, Jimenez-Ayala Portillo B (eds). Endometrial Adenocarcinoma: Prevention and early diagnosis. Basel S Karger AG 2008; 32-36.

Dutta M, Talukdar KL. A histological study of uterus in reproductive and postmenopausal women. NJCA 2015; 4: 17-25.

Sivridis E, Giatromanolaki A. Proliferative activity in postmenopausal endometrium: The lurking potential for giving rise to an endometrial adenocarcinoma. J Clin Pathol 2004; 57(8): 840-844.

Archer DF, McIntyre-Seltman K, Wilborn WW Jr, et al. Endometrial morphology in asymptomatic postmenopausal women. Am J Obstet Gynecol 1991; 165(2): 317-320.

Korhonen MO, Symons JP, Hyde BM, et al. Histologic classification and pathologic findings for endometrial biopsy specimens obtained from 2,964 perimenopausal and postmenopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 Study). Am J Obstet Gynecol 1997; 176(2): 377-380.



  • There are currently no refbacks.