Dynamic contrast-enhanced MRI to characterize angiogenesis in primary epithelial ovarian cancer: An exploratory study

Auni Lindgren; Maarit Anttila; Otso Arponen; Kirsi Hämäläinen; Mervi Könönen; Ritva Vanninen; Hanna Sallinen

doi:10.1016/j.ejrad.2023.110925

Dynamic contrast-enhanced MRI to characterize angiogenesis in primary epithelial ovarian cancer: An exploratory study

Eur J Radiol. 2023 Aug:165:110925. doi: 10.1016/j.ejrad.2023.110925. Epub 2023 Jun 11.

Authors

Auni Lindgren¹, Maarit Anttila², Otso Arponen³, Kirsi Hämäläinen⁴, Mervi Könönen⁵, Ritva Vanninen⁶, Hanna Sallinen⁷

Affiliations

¹ Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Obstetrics and Gynaecology, Kuopio, Finland. Electronic address: auni.lindgren@pshyvinvointialue.fi.
² Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Obstetrics and Gynaecology, Kuopio, Finland.
³ Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
⁴ Department of Pathology and Forensic Medicine, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, Kuopio, Finland.
⁵ Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland.
⁶ Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, Clinical Radiology, Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
⁷ Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.

PMID: 37320880
DOI: 10.1016/j.ejrad.2023.110925

Abstract

Purpose: Angiogenesis is essential for tumor growth. Currently, there are no established imaging biomarkers to show angiogenesis in tumor tissue. The aim of this prospective study was to evaluate whether semiquantitative and pharmacokinetic DCE-MRI perfusion parameters could be used to assess angiogenesis in epithelial ovarian cancer (EOC).

Method: We enrolled 38 patients with primary EOC treated in 2011-2014. DCE-MRI was performed with a 3.0 T imaging system before the surgical treatment. Two different sizes of ROI were used to evaluate semiquantitative and pharmacokinetic DCE perfusion parameters: a large ROI (L-ROI) covering the whole primary lesion on one plane and a small ROI (S-ROI) covering a small solid, highly enhancing focus. Tissue samples from tumors were collected during the surgery. Immunohistochemistry was used to measure the expression of vascular endothelial growth factor (VEGF), its receptors (VEGFRs) and to analyse microvascular density (MVD) and the number of microvessels.

Results: VEGF expression correlated inversely with K^trans (L-ROI, r = -0.395 (p = 0.009), S-ROI, r = -0.390, (p = 0.010)), V_e (L-ROI, r = -0.395 (p = 0.009), S-ROI, r = -0.412 (p = 0.006)) and V_p (L-ROI, r = -0.388 (p = 0.011), S-ROI, r = -0.339 (p = 0.028)) values in EOC. Higher VEGFR-2 correlated with lower DCE parameters K^trans (L-ROI, r = -0.311 (p = 0.040), S-ROI, r = -0.337 (p = 0.025)) and V_e (L-ROI, r = -0.305 (p = 0.044), S-ROI, r = -0.355 (p = 0.018)). We also found that MVD and the number of microvessels correlated positively with AUC, Peak and WashIn values.

Conclusions: We observed that several DCE-MRI parameters correlated with VEGF and VEGFR-2 expression and MVD. Thus, both semiquantitative and pharmacokinetic perfusion parameters of DCE-MRI represent promising tools for the assessment of angiogenesis in EOC.

Keywords: Angiogenesis; Dynamic Contrast-Enhanced MRI; Epithelial Ovarian cancer; Magnetic Resonance Imaging; Microvessels; Vascular Endothelial Growth Factor A.

MeSH terms

Carcinoma, Ovarian Epithelial / diagnostic imaging
Contrast Media / pharmacokinetics
Female
Humans
Magnetic Resonance Imaging / methods
Ovarian Neoplasms* / diagnostic imaging
Ovarian Neoplasms* / pathology
Prospective Studies
Vascular Endothelial Growth Factor A* / metabolism
Vascular Endothelial Growth Factor Receptor-2

Substances

Vascular Endothelial Growth Factor A
Vascular Endothelial Growth Factor Receptor-2
Contrast Media