Dynamic contrast-enhanced magnetic resonance imaging is a poor measure of rectal cancer angiogenesis

Background: The aim of this study was to investigate the use of magnetic resonance imaging (MRI) for non-invasive measurement of rectal cancer angiogenesis and hypoxia. Methods: Fifteen patients with rectal adenocarcinoma underwent preoperative dynamic contrast-enhanced (DCE) and blood oxygenation level-dependent (BOLD) MRI. Microvessel density (CD31 level), and expression of vascular endothelial growth factor (VEGF) and carbonic anhydrase (CA) 9 were measured immunohistochemically in histological turnout sections from 12 patients. Serum VEGF levels were also measured in 14 patients. Correlations between quantitative imaging indices and immunohistochemical variables were examined. Results: There was good correlation between circulating VEGF and CD31 expression (r(s) = 0.88, P < 0.001). CD31 expression did not correlate with any dynamic MRI parameter, except transfer constant, with which it correlated inversely (r(s) = -0.65, P = 0.022). Tissue and circulating VEGF levels did not correlate, and neither correlated with any turnout DCE MRI parameter. No relationship was seen between BOLD MRI and CA-9 expression. Conclusion: The negative correlation between transfer constant (reflecting turnout blood flow and microvessel permeability) with CD31 expression is paradoxical. DCE MRI methods for assessing tissue vascularity correlate poorly with histological markers of angiogenesis and hypoxia, suggesting that DCE MRI does not simply reflect static histological vascular properties in patients with rectal cancer.