Objective To investigate the value and imaging characteristics of diffusion weighted imaging (DWI) combined with apparent diffusion coefficient (ADC) in differential diagnosis of degenerative uterine fibroids (DUF). Methods The clinical data of 72 patients with DUF were analyzed retrospectively. All patients were examined by DWI and the ADC value was obtained. With results of pathological examination as a the golden standard, DWI image characteristics were analyzed, the accuracy, specificity and sensitivity in differential diagnosis of DUF were compared between DWI images, ADC value and DWI inages combined with ADC value. Results Pathological confirmed diagnosis showed that there were 22 cases (30.56%) of uterine sarcomas and 50 cases (69.44%) of benign DUF. DWI images of DUF showed cystic change and necrosis signs. DWI images of uterine sarcoma showed relatively higher signal intensity, fuzzy tumor edges and obvious surrounding endometrial involvement. The signal intensity of benign DUF was uncertain, the tumor edges were regular, and there almost was no involvement of surrounding endometrium. The diagnostic accuracy and specificity of DWI combined with ADC were significantly higher than those of DWI alone or ADC alone (P<0.05). The sensitivity of combined diagnosis was significantly higher than that of DWI alone (P<0.05), but there was no significant difference, compared with the diagnosis of ADC alone (P>0.05). Conclusion DWI imaging characteristics of two kinds of DUF are obviously different, and the combined detection with ADC can improve the diagnostic accuracy.