MRI insights into endometrial stromal tumors

Preoperative misdiagnosis and the adoption of incorrect surgical approaches occur frequently in patients with endometrial stromal tumors (ESTs) because of their rarity, nonspecific clinical manifestations, and imaging features that highly overlap with those of other benign uterine tumors, thereby increasing the risk of secondary surgery and adverse outcomes. Thus, accurate diagnosis is essential, and following initial clinical and sonographic assessments, MRI serves as the cornerstone imaging technique for further characterization and differential diagnosis. Radiologists must be familiar with and adept at interpreting these images to narrow the differential diagnosis and at least suggest the possibility of EST. This article describes the imaging manifestations of various ESTs and highlights characteristic radiological features that enable radiologists to refine the differential diagnosis, thereby assisting clinicians in determining appropriate treatment strategies. KEY POINTS: Question Preoperative differentiation of ESTs from benign uterine lesions remains challenging and may result in the adoption of the incorrect surgical approach. Findings Key MRI features include homogeneous T2WI hyperintensity without speckles, T2WI hypointense bands, a worm‑like appearance, multilocular cystic changes, and feather‑like enhancement. Critical Relevance Statement This review comprehensively describes the MRI findings of ESTs and provides an educational summary based on tumor location, morphology, and key features to substantially improve diagnostic confidence.