Fig. 4

A 45-year-old premenopausal female with history of breast cancer. The patient received tamoxifen therapy for 1 year. By TVS examination, the endometrium showed diffuse enlargement, measuring about 20 mm in diameter at the fundus with variable sized cystic changes inside. a, b Sagittal and axial T2 WIs show enlarged endometrium with heterogeneous signal intensity (blue arrows) due to associated cystic changes, and prominent stromal proliferation. c Axial DWI with b value of 1000 s/mm² shows high signal intensity of the thickened endometrium with central areas of intermediate SI (red arrow). d Axial DW-ADC map image shows thickened endometrium with intermediate signal intensity. Mean DW-ADC value = 1.232 × 10⁻³ mm²/s. e, f Sagittal and axial DTI map images demonstrate values of DT-FA and DT-MD in multiple ROI along the thickened endometrium. Mean DT-FA value = 0.299, and mean DT-ADC (MD) value = 1.552 × 10⁻³ mm²/s. Diagnosis: Tamoxifen-induced endometrial hyperplasia