Background: Blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) is a functional MRI technique which involves using the paramagnetic properties of deoxyhemoglobin to image the local tissue oxygen concentration. The purpose of this study was to investigate whether BOLD-MRI could evaluate hypoxia and angiogenesis of breast invasive ductal carcinoma (IDC). Methods: Ninety-eight female patients with IDC were retrospectively included in this research. All patients underwent breast BOLD-MRI at 3.0 T before surgery. R2* values of BOLD-MRI were measured. The expression of carbonic anhydrase IX (CA IX) and vascular endothelial growth factor (VEGF) was analyzed by immunohistochemistry. Spearman's correlation analysis was used to correlate R2* value with CA IX and VEGF levels. Results: Heterogeneous intensity on BOLD-MRI images was the main finding of IDCs. The mean R2* value was 52.8 +/- 18.6 Hz. The R2* values in patients with axillary lymph node metastasis were significantly higher than the R2* values in patients without axillary lymph node metastasis (t = 2.882, P = 0.005). R2* values increased with CA IX level and positively correlated with the level of CA IX (r = 0.616, P < 0.001); however, R2* value had no significantly correlation with the level of VEGF (r = 0.110, P = 0.281). Conclusion: BOLD-MRI could noninvasively evaluate chronic hypoxia of IDC, but not angiogenesis.