Iranian Journal of Radiology
Volume:17 Issue: 4, Oct 2020

Epicardial adipose tissue (EAT) may play a vital role in the progression of ischemia and no obstructive coronary artery disease (INOCA). CT can achieve a precise quantification of EAT for its higher spatial resolution compared to other methods.

This study aimed at exploring EAT in patients with INOCA, and its associations with other clinical factors.

From January 2017 to October 2018, a total of 254 consecutive patients suspected with coronary atherosclerotic disease (CAD) underwent cardiac computed tomography angiography (CCTA). There were 195 patients who were excluded for obstructive CAD by CCTA analysis and CT derived fractional flow reserve (CT-FFR) (≤ 0.80). Seventy-two patients with either angina and/or signs of ischemia but without obstructive CAD were recruited as INOCA group. Forty-eight controls without angina and risk factors for INOCA were enrolled as the control group. EAT volume and thickness, and other factors were analyzed in INOCA and control groups.

Despite similar body mass index (BMI), EAT thickness and volume were significantly elevated in INOCA patients compared with the control group (P < 0.001). Receiver operating characteristic curve analysis for identifying INOCA exhibited a higher area under the curve of EAT volume (0.773, 95%CI 0.616-0.930) than EAT thickness (0.692, 95%CI 0.597-0.786). The cut-off values for EAT thickness and volume were 3.2 mm and 179.6 cm3 , respectively. Presence of hypertension, triglyceride levels, and EAT thickness and volume were significantly associated with INOCA and lowly affected by other factors in multiple logistic regression analysis.

INOCA patients have more EAT compared with controls. EAT is a marker of INOCA and may be a predictor of pharmacological therapy and a prognostic indicator. Further research should focus on the myocardial microcirculation changes by EAT volume reduction.

Studies have shown that CT could be valuable for prognostic issues in COVID-19.

To investigate the prognostic factors of early chest CT findings in COVID-19 patients.

This retrospective study included 91 patients (34 women, and 57men) of real-time reverse transcription polymerase chain reaction (RT-PCR) positive COVID-19 from three hospitals in Iran between February 25, 2020, to March 15, 2020. Patients were divided into two groups as good prognosis, discharged from the hospital and alive without symptoms (48 patients), and poor prognosis, died or needed ICU care (43 patients). The first CT images of both groups that were obtained during the first 8 days of the disease presentation were evaluated considering the pattern, distribution, and underlying disease. The total CT-score was calculated for each patient. Univariate and multivariate analysis with IBM SPSS Statistics v.26 was used to find the prognostic factors.

There was a significant correlation between poor prognosis and older ages, dyspnea, presence of comorbidities, especially cardiovascular and comorbidities. Considering CT features, peripheral and diffuse distribution, anterior and paracardiac involvement, crazy paving pattern, and pleural effusion were correlated with poor prognosis. There was a correlation between total CT-score and prognosis and an 11.5 score was suggested as a cut-off with 67.4% sensitivity and 68.7% specificity in differentiation of poor prognosis patients (patients who needed ICU admission or died). Multivariate analysis revealed that a model consisting of age, male gender, underlying comorbidity, diffused lesions, total CT-score, and dyspnea would predict the prognosis better.

Total chest CT-score and chest CT features can be used as prognostic factors in COVID-19 patients. A multidisciplinary approach would be more accurate in predicting the prognosis.

Spontaneous portosystemic shunts (SPSS) are one of the hallmarks of Budd-Chiari syndrome (BCS). Ultrasound can accurately show the location and type of portosystemic collaterals.

To study the sonographic feature of SPSS in patients with BCS and to evaluate differences in the main portal vein diameter among multiple types of portosystemic shunts. Patients and

Ultrasonographies of 44 patients with SPSS among 352 BCS patients between June 2000 and November 2015 were reviewed retrospectively. The SPSS in 44 BCS patients were first detected by ultrasound and then confirmed via digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance venography (MRV). The location, course, diameter and hemodynamics of the spontaneous portosystemic shunts were observed by ultrasound. In addition, one-way analysis of variance (ANOVA) was performed to evaluate the difference in the main portal vein diameter between the different shunt types.

The blood drainage patterns of SPSS in 44 of 352 patients with BCS were classified as the following five types: portalumbilical shunts (15/44), portal-hepatic shunts (11/44), portal-accessory hepatic shunts (6/44) (the accessory hepatic veins included the inferior right hepatic vein and the caudate lobe vein), splenorenal shunts (8/44) and main portal vein-inferior vena cava shunts (4/44). The corresponding hemodynamics of the five types mentioned above were obtained. Main portal vein-inferior vena cava shunts had a significantly larger mean portal trunk diameter compared with all other types (P < 0.05 for all comparisons). In addition, the mean portal trunk diameters in portal-umbilical shunts and portal-hepatic shunts were obviously larger than that of splenorenal shunts (P < 0.05), while there were no statistically significant differences between the other types.

Spontaneous portosystemic shunts are not rare in patients with BCS. Ultrasound is a reliable means for their diagnosis and it offers substantial information for use in clinical treatment.

There is a higher possibility for rheumatoid arthritis (RA) recurrence if patients have subclinical synovitis. Sevenjoint ultrasonic score (US7 score) allows an accurate detection of subclinical synovitis, but its predictive role in the recurrence of RA patients in remission is uncertain.

The goal of this study was to explore the role of US7 score in predicting the recurrence of RA patients with disease in clinical remission. Patients and

Totally, 186 RA patients in clinical remission were recruited and their demographic and clinicobiologic characteristics were collected. The US7 score and disease activity score in 28 joints (DAS28) were recorded as baseline indicators for a 1-year follow-up. Patients were divided into the recurrence group and non-recurrence group according to their recurrent results. The clinical indicators and US7 scores before the follow-up were compared and analyzed between the two groups. Kaplan-Meier and univariate COX regression analysis were used to analyze the effect of US7 score on the recurrence of RA. Receiver-operating characteristics (ROC) curves were established to evaluate the predictive accuracy of DAS 28 and US7 score for the outcome of RA.

Of the 186 RA patients, 55.9% received conventional disease-modifying antirheumatic drugs (cDMARDs) and 44.1% received biologic disease-modifying antirheumatic drugs (bDMARDs). Totally, 60 patients (32.3%) suffered from recurrence and were included in the recurrence group, and the remaining 126 patients were included in the non-recurrence group. The recurrence rate of patients without subclinical synovitis (10.26%) was lower than that of patients with subclinical synovitis (48.15%, χ 2 = 27.556, P < 0.001). US7 score was associated with an increased risk of recurrence in RA patients after successful treatment (P < 0.001, hazard ratio = 1.363, 95% CI = 1.247 - 1.488). The area under the curve of the prediction model with combined US7 score and DAS 28 was higher (0.904) compared to that of US7 score or DAS 28 (P < 0.05).

The US7 score is capable of predicting the recurrence of RA patients because of its advantages in identifying subclinical synovitis. The combined model of DAS28 and US7 score was accurate for predicting the recurrence of RA patients in clinical remission.

Intra-arterial thrombectomy (IAT) is one of the mainstream treatments for acute ischemic stroke. As relatively little evidence on extracranial internal carotid artery (ICA) occlusions exists in the literature, we share our experiences after using IAT for intracranial and extracranial ICA occlusions. We further clarify the imaging characteristics of multiphase computed tomography angiography (CTA) and share the experience of balloon angioplasty in acute ICA occlusion.

To investigate the imaging findings of multiphase CTA and the clinical conditions and outcomes of acute ICA occlusions at different segments after IAT. Patients and

All participants receiving IAT for acute stroke with isolated ICA occlusions were included, obtained from three hospitals between June 2016 and November 2018. An imaging review for non-enhanced computed tomography (CT), multiphase CTA, and angiography was conducted. Epidemiological and clinical data were reviewed. Further comparisons were evaluated between the occlusion side from the C6 to C7 segments and C1 to C5 segments of the ICA.

The average age of the patients was 73.0 years, and the initial National Institutes of Health Stroke scale (NIHSS) score was 18.6. Nineteen percent of cases had good outcomes. Good reperfusion results were achieved in 50% of cases. Compared to the group with occlusion from C6-C7, the group with occlusion from C1-C5 had a relatively good Alberta Stroke Program Early CT score (ASPECTS) in the A1 phase of the multiphase CTA, and more patients had a good collateral. Three cases received a balloon angioplasty for a concurrent proximal cervical ICA tight stenosis, and all cases had good reperfusion results.

Distal occlusion of the ICA demonstrates lower ASPECTS and a worse collateral on multiphase CTA. A multiphase CTA with an extended scan range in the A2 and A3 phases is able to exclude pseudo-occlusion of the ICA. Balloon angioplasty is helpful for concurrent proximal cervical ICA tight stenosis.

Breast cancer may result in remodeling of adjacent normal appearing breast tissues. Magnetic resonance imaging (MRI) is increasingly used in the diagnosis and follow-up of breast cancer by means of diffusion weighted imaging, which is based on thermal motion of water molecules in the extracellular fluid.

We investigated the correlation of visual assessment of peri-tumoral edema with peri-tumoral and tumoral apparent diffusion coefficient (ADC) values. Patients and

In this cross-sectional study, from 2016 to 2018, 78 patients with 89 malignant breast lesions (mean age, 47 years) were examined by 1.5-T breast MRI. The lesions were categorized based on the visual assessment of peri-tumoral edema on T2 weighted imaging (T2WI) into two groups: (A) with edema (36 lesions) and (B) without edema (53 lesions). Measuring ADC values in the contralateral normal breast tissue, peri-tumoral tissue and peri-tumoral-normal tissue ADC ratio were compared between the two groups for all lesions.

The number of in situ lesions was higher in group B (7.5% vs 2.7%) with the p value of 0.01. The mean of ADC values in the normal breast tissue was 1.76 × 10-3mm2 /s. Tumor ADCs were significantly lower in group A compared to group B (0.95 × 10-3mm2 /s vs. 1.11 × 10-3mm2 /s) with the P value of 0.003. However, peri-tumoral ADCs were significantly higher in group A (1.82 × 10-3mm2 /s vs. 1.53 × 10-3mm2 /s) with the p value of 0.005. The peri-tumoral-normal tissue ADC ratio was 0.87 in group B and about 1 in group A. However, the difference between normal tissue ADCs and peri-tumoral ADCs was only significant (P value of 0.005) in group B. The cut-off point value for differentiating normal tissue ADCs and peri-tumoral ADCs was 1.61×10-3mm2 /s with the sensitivity of 65% and specificity of 70%.

Breast cancer with peri-tumoral edema has lower tumoral ADC values, higher peri-tumoral ADC values and lower prevalence of in situ lesions. Visual assessment of peri-tumoral edema on T2WI could predict the tumoral characteristic on diffusionweighted imaging.

Chest CT scan is frequently used for diagnosis of coronavirus disease 2019 (COVID-19), especially in regions with limited availability of reverse-transcription polymerase chain reaction test (RT-PCR) test. Low-dose CT of chest offers acceptable image quality with lower radiation dose, particularly important in younger patients.

We have designed the current study to evaluate the diagnostic efficacy of low-dose chest CT versus early RT-PCR results, for triage of COVID-19 patients. Patients and

From February 20 to April 15, 2020, 163 patients including 100 males (61.3%) with the median age of 65 years (21 to 97), who underwent both RT-PCR and chest CT were registered in the study. Low-dose chest CT protocol was applied with parameters modified from the lung cancer screening protocol. The accuracy of low-dose chest CT for COVID-19 diagnosis was evaluated, considering first RT-PCR results as reference.

Of 163 patients, 89 cases (54.6%) were presented with positive initial RT-PCR result. Lymphocyte percentage and lymphocyte count were significantly lower in the positive RT-PCR group (15% versus 19%, and 0.98 vs. 1.3, respectively); while, erythrocyte sedimentation rate (ESR) was significantly higher (53 vs. 22). Positive chest CT Findings were present in 133/163 cases (81.6%). The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of low-dose chest CT scan were 96.6% (95% confidence interval [CI], 90% - 99%), 36.5% (95% CI, 26% - 49%), 64.7% (95% CI, 56% - 73%), 90% (95% CI, 72% - 97%) and 69.3% (95% CI, 61% - 76%), respectively based on positive RT-PCR results.

Low-dose chest CT scan provides both high sensitivity and negative predictive value in diagnosing COVID-19 compared to initial RT-PCR as the gold standard. It can be used as an alternate to standard-dose CT scan in areas with high prevalence of COVID19 disease and limited availability of RT-PCR for early triage.

Triple assessment of breast pathologies is a very important pathway to detect breast cancers earlier.

To ascertain the necessity of clinical-guided core biopsy (CGCB) or fine-needle aspiration cytology (FNAC) for investigating clinically indeterminate breast lesions with no significant imaging findings. Patients and

Retrospective analysis of 72 patients who had clinical core biopsy or fine-needle cytology was carried out to investigate clinically indeterminate breast lesions with normal imaging during the period from September 2017 to September 2019.

Out of 72 patients, 61 clinically indeterminate breast lesions (P3) were investigated and showed that 39 lesions (63.9%) were graded as B1, 17 lesions (27.8%) were graded as B2, two lesions (3.2%) were graded as B3 showing atypia, no lesions were graded as B4, two lesions (3.2%) were graded as B5 (one [1.6%] was found to be invasive lobular carcinoma [ILC] and the other one [1.6%] was found to be metastatic colorectal cancer to the breast), while one lesion investigated by FNAC was graded as C2 (1.6%).

CGCB or FNAC is still necessary and vital for investigating clinically indeterminate breast lesions with normal imaging.

A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported worldwide, but there are few reports on age-related CT signs and clinical characteristics of COVID-19 patients.

We aimed to analyze the CT imaging characteristics and clinical features of elderly patients with novel coronavirus disease 2019 (COVID-19) and compare them with young COVID-19 patients, in order to provide imaging basis for clinical diagnosis. Patients and

The clinical and chest CT imaging data of elderly patients (≥ 60 years) and young patients (age of 20 - 60 years) with positive novel coronavirus nucleic acid admitted to our hospital from January 28, 2020 to February 16, 2020 were retrospectively analyzed, and the differences in clinical and imaging characteristics between the two groups were compared.

One hundred eighty three COVID-19 patients (96 elderly: mean age, 72.76 ± 5.65; 87 young: mean age, 42.69 ± 12.44) with positive novel coronavirus nucleic acid were retrospectively enrolled. The clinical symptoms of fever (79%), cough (64%) and weakness (59%) in elderly patients were higher than those of young patients (P < 0.01). Asymptomatic young patients (15%) were more common than the elderly (2%) (P < 0.01). Twenty-four patients (13%) had lesions that involved both the periphery and the center of the lung, while the lesions were located in the periphery of the lung in 159 patients (87%). Ground-glass opacification in young patients (71%) was significantly higher than that of the elderly (26%) (P < 0.001). Compared with the young group (37%), the proportion of extensive involvement of lung lobes was higher in the elderly group (72%) (P < 0.001).

Elderly and young patients with corona virus disease had some common CT and clinical features, but elderly patients may have relatively severe CT findings, and these differences may be related to the severity and prognosis of COVID-19 pneumonia.

Accurately assessing the efficacy of radiofrequency ablation for hepatocellular carcinoma (HCC), and early detection of tumor residues or recurrence after radiofrequency ablation is important to improve the prognosis of patients with HCC.

To investigate the application of gemstone spectral imaging in the evaluation of abnormal enhancement of the edge of HCC after radiofrequency ablation. Patients and

From November 2013 to April 2019, patients with HCC admitted to the department underwent regular gemstone spectral imaging and energy spectrum analysis after radiofrequency ablation. The abnormal enhancement within and around the radiofrequency ablation lesion was observed, and the energy spectrum data of the radiofrequency ablation lesion and the abnormal enhancement focus were measured.

A total of 133 lesions with marginal enhancement following radiofrequency ablation were included. Of these lesions, 62 were eventually diagnosed as inflammatory reaction zone, and 71 were diagnosed as residual or recurrent HCC. The results of energy spectrum analysis showed that there was a statistically significant difference in the iodine concentration between the inflammatory reaction zone and the residual or recurrent HCC (P < 0.001). The iodine concentration in the inflammatory reaction zone was lower than the iodine concentration in the residual or recurrent HCC (9.70±3.00 100 µg/mL vs. 13.24 ± 4.51 100 µg/mL). In the enhanced arterial and portal venous phases, the difference between the slope of the energy spectrum curve of the inflammatory reaction zone and the residual or recurrent HCC was statistically significant (P < 0.001).

Gemstone spectral imaging can effectively differentiate residual or recurrent HCC from the inflammatory reaction zone after radiofrequency ablation. It is conducive to early detection of residual or recurrent tumors, helps clinicians formulate the next treatment plan, and improves the prognosis of patients.

Osteoporosis is a globally common disorder with significant burdens on the quality of life, and therefore, presents the need for a viable screening tool.

To establish the diagnostic value of opportunistic computed tomography (CT) scan performed routinely on urinary stone patients for identifying and screening osteoporosis, through measuring vertebral trabecular bone attunement in Hounsfield Units. Patients and

Consecutive subjects were enrolled in this cross-sectional study, who suffered from urinary stones and were undergoing percutaneous nephrolithotomy (PCNL) procedure for stone removal at a tertiary referral hospital. The CT imaging data for the patients were retrospectively extracted, and the patients then underwent a dual energy X-ray absorptiometry (DEXA) scan as the standard protocol in measuring bone mineral density (BMD). CTs were assessed, measuring the bone mineral attenuation at the L1 vertebral level. Diagnostic performance protocols and data comparison with DEXA results were measured.

Ninety-two patients were enrolled in the study, 31 (34%) of which were designated as osteoporotic according to standard definitions based on DEXA. Vertebral attunement measurements showed sufficient diagnostic performance, with an area under the curve (AUC) of 0.983 (95% confidence interval [CI], 0.961 – 1.000), 93.55% sensitivity (95% CI, 78.55 – 99.21) and 90.16% specificity (95% CI, 79.81 – 96.30) at the pre-designed 160 Hounsfield units (HU) discriminatory threshold.

This study showed that in a high-risk population, vertebral trabecular bone attenuation values retrieved from routine CT imaging holds significant diagnostic value when compared to the gold-standard DEXA, and can be utilized as a viable screening method.

To describe the characteristics of computed tomography (CT) in patients with 2019 novel coronavirus (COVID-19) pneumonia and their changes during disease progression. Patients and

A total of 96 chest CT scans of 61 pneumonia patients associated with COVID-19 were reviewed to identify CT features associated with the time of symptom onset and the evolution of disease.

The initial CTs of 61 patients were obtained during 1 to 11 days after the onset. The main CT pattern of initial CT obtained during 1 - 3 days after the symptom onset was single (7/23, 35%) or multiple ground-glass opacity (GGO, 8/23, 35%). At 4 - 7 days after the symptom onset, the main imaging features were crazy paving GGO mixed with partial consolidation pattern (15/32, 47%). At 8 - 11 days after the symptom onset, the CT images showed consolidation pattern (3/6, 50%). A total of 35 follow up CTs were collected. The mean interval time between each follow up CT was 3 ± 2 days. The CT patterns also changed with the evolution of the disease: the features of GGO manifested at the early stage (1 - 3d). The crazy paving GGO pattern, consolidation pattern and mixed with partial consolidation pattern were found 4 to 14 days after the onset. In the absorption stage (15 - 24d), both density and extent of lesions were reduced.

The CT imaging features are associated with the time of symptom onset and evolution of disease. Understanding the imaging characteristics of each stage is very helpful for understanding the development of disease.

The patellofemoral joint parameters and imaging presentations of patellar tumors and tumor-like lesions are not clear.

The aim of this case-control study was to investigate patellofemoral joint parameters, clinical data and findings in patients with patellar tumors and tumor-like lesions. Patients and

Twenty-nine patients with patellar diseases were enrolled. Morphological measurement was performed and analyzed in fourteen patients with patellar tumors (tumor group) and another fifteen patients without patellar diseases (control) who had complete computed tomography data as the control group.

Among 29 patients, there were twenty benign lesions (69.0%) and nine malignant tumors (31.0%). Benign lesions included chondroblastoma in nine patients (31.0%), giant cell tumor of bone in four (13.8%), chondroma in one (3.4%), hemangioma in one (3.4%), parosteal lipoma in one (3.4%), bone cyst in two (6.8%), aneurysmal bone cyst in one (3.4%), and fibrous dysplasia in one (3.4%). Malignant tumors were bone metastasis in four patients (13.8%), osteosarcoma in three (10.3%) including common osteosarcoma in two and well-differentiated osteosarcoma in the remaining one, chondrosarcoma in one (3.4%) and hemangiopericytoma in one (3.4%) patient. Chondroblastomas, giant cell tumors and fibrous dysplasia showed findings of expansile bone destruction lesions in imaging. Malignant tumors had bone destruction with ill-defined margins. The femoral trochlear angle was significantly greater in the tumor than the control group (P < 0.001, 159.19º ± 9.42º vs. 135.00º ± 5.50º), whereas the lateral pulley inclination (P = 0.01, 14.69º±8.91º vs. 20.73º±3.51º) and trochlear depth (P < 0.001, 3.10±1.79 vs. 6.67±1.26 mm) were significantly smaller in the tumor than the control group.

The patellar tumors are mainly benign and rarely malignant. Comprehensive understanding of the distribution, incidence and imaging features of patellar tumors and patellofemoral morphological parameters can improve the diagnosis accuracy

An obturator hernia is a rare type of abdominal hernia that can cause acute intestinal obstruction. Meckel’s diverticulum, the most common gastrointestinal tract malformation, is an uncommon cause of intestinal obstruction. The combination of obturator hernia and Meckel’s diverticulum is extremely rare. We report a rare case of obturator hernia with Meckel’s diverticulum in a 76-year-old woman who presented at the emergency room with complaints of abdominal pain. The diagnosis was confirmed by a computed tomography (CT) scan and exploratory laparotomy. Since obturator hernia is uncommon and rarely associated with Meckel’s diverticulum, we described the imaging features in this case study.

Primary thymic mucinous adenocarcinoma is a very rare disease. Its clinical findings are not well known. Its prognosis is poor. We present a case of primary thymic mucinous adenocarcinoma in a 60-year-old woman. The patient visited the emergency room with dysarthria as a chief complaint, and a mass was found in the occipital bone and petrous apex in brain computed tomography (CT) and magnetic resonance imaging (MRI). The lesion was considered metastasis, and body CT evaluation was performed to find the primary origin. In CT, a large peripheral enhancing mass with central low attenuation and calcification was found in the anterior mediastinum. Pathologic confirmation of the anterior mediastinal mass was done by percutaneous needle biopsy procedure. The patient was diagnosed with primary thymic mucinous adenocarcinoma. We also reviewed and analyzed previous literature focusing on radiologic findings. The possibility of primary thymic mucinous adenocarcinoma should be considered if a large mass with a heterogeneous enhancement pattern is accompanied by adjacent tissue involvement, associated thymic cyst, or calcification.

Coronavirus disease 2019 (COVID-19) is currently a pandemic affecting the world, and there is no specific therapeutic drug available. Hypoxemia is a common clinical manifestation of severe patients, and oxygen therapy is the main treatment. This article reports for the first time the computed tomography (CT) imaging dynamic changes in a case of 69-year-old male with severe type of COVID-19 treated by hyperbaric oxygen, which provides a more effective regimen for severe COVID-19 patients with hypoxemia. We emphasize that hyperbaric oxygen treatment for COVID-19 is a preliminary attempt, and more clinical studies are required to confirm its efficacy

Superior semicircular canal dehiscence (SSCD) is known as abnormal communication of the superior semicircular canal (SCC) to the intracranial space secondary to a bony defect in the canal. Patients who are subjected to surgical repair usually have intractable symptoms, and recently, plugging of SCC using a transmastoid approach has been widely recommended. In this report, we describe a case of incomplete plugging for SSCD in a 37-year-old woman, along with the high-resolution three dimensional magnetic resonance imaging (3D MRI) findings using Pöschl view reconstruction. Postoperative MRI of 3D T2-wieghted SPACE Pöschl plane demonstrated an incomplete plugging of the SCC with partially visible perilymphatic fluid in the posterior limb above the common crus. A 3D fluid-attenuated inversion recovery (FLAIR) sequence showed an enhancement involving the vestibule and SCC, suggesting labyrinthitis. Although there are few reports about incomplete plugging for SSCD, this case could demonstrate postoperative status and complication after plugging of SSCD using a high-resolution 3D MRI sequences with Pöschl view reconstruction.

Primary yolk sac tumor (YST) of the endometrium is a very rare malignant germ cell tumor, primary YST of the endometrium with detailed magnetic resonance imaging (MRI) and contrast-enhanced MRI (CE-MRI) findings have not yet been reported in the English literature. We report a 40-year-old woman presenting with irregular lower abdominal pain and dysmenorrhea for more than 5 months. MRI showed a lesion in the right side wall of the uterus. Postoperative pathology and immunohistochemistry confirmed the diagnosis of primary YST of the endometrium with the International Federation of Gynecology and Obstetrics (FIGO) system staging of IV. The signal of the tumor was complex and lacked specific characteristic. Diffusion-weighted imaging (DWI) showed that the lesion is diffuse limited, the average apparent diffusion coefficient (ADC) value of the solid component was 0.735 × 10-3 mm2 /s. CE-MRI showed that the irregular lesions presented uneven and mild enhancement in the arterial stage, and continued to strengthen in the venous phase, and strengthened close to the myometrium in the delayed phase. Primary YST of the endometrium should be considered if MRI scans show an irregular lesion in the myometrium with high level of alpha-fetoprotein (AFP).