Objective To explore the application value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis and pathological grading evaluation of uterine fibroids. Methods 605 patients who were suspected of uterine fibroid and admitted to the hospital from January 2021 to January 2023 were included in this study. With postoperative pathological results as the gold standard, the value of DCE-MRI in the diagnosis and pathological classification of uterine fibroids was evaluated. Results With postoperative pathological results as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of DCE-MRI for diagnosing uterine fibroids were 88.41%, 95.90%, 89.92%, 98.84%, 67.63% and 0.869, respectively. Kep, Ve and Ktrans of patients with cellular uterine fibroids were significantly higher than those of patients with normal and degenerative uterine fibroids (P＜0.05). The area under the curve and specificity of the combination of Kep, Ve and Ktrans for predicting cellular uterine fibroids (0.878 and 96.47%) were higher. Kep, Ve and Ktrans of patients with uterine sarcoma were significantly higher than those of patients with benign degenerative uterine fibroids (P＜0.05). The area under the curve and sensitivity of the combination of Kep、Ve and Ktrans for predicting uterine sarcoma (0.867 and 82.54%) were higher. Conclusion DCE-MRI is of high value in the diagnosis and pathological grading evaluation of uterine fibroids