MRI characterization of tumors and grading angiogenesis using macromolecular contrast media: status report

Magnetic resonance imaging (MRI) enhanced with a macromolecular contrast medium (MMCM) has been applied successfully to assay tumor microvascular characteristics. These MRI-assayed characteristics correlate closely with histologic microvascular density, an established surrogate of tumor angiogenesis, and with pathologic tumor grade. The utility of MMCM-enhanced MRI for tumor characterizations has been established experimentally in a range of cancer types including breast, ovary, fibrosarcoma, and prostate. The MMCM-enhanced MRI technique can also be applied to monitor changes in tumor vessels that result from administration of an angiogenesis inhibitor, antibody against vascular endothelial growth factor (VEGF). Suppression of microvascular permeability (up to 98%) induced by this inhibitor of angiogenesis was detected and quantified as soon as 24 h after initiation of therapy. Thus, MRI assays of tumor microvascular characteristics, particularly macromolecular permeability, provide a means to non-invasively characterize tumors for prognostication, for individualization and optimization of treatment, and for monitoring therapeutic response. Pending successful completion of drug trials, now in progress, the availability of MMCM should permit the immediate application of these powerful techniques in clinical practice.