ESM1 and neoplasm: Intratumor hypoenhancement, including severe ischemic or necrosis, is related to endothelial-specific molecule 1 (ESM-1), angiopoietin 2 (Ang-2), and vascular endothelial growth factor A (VEGFA) expression in the tumor leading to peripheral tumor angiogenesis, hypoxia, rapid growth, and subsequent reduced central perfusion (25, 26).