Dynamic Contrast-Enhanced MRI in Neuro-Oncology: A Narrative and Translational Review.
Authors
Affiliations (8)
Affiliations (8)
- Neuroradiology Unit, Diagnostic Department, University Hospital of Parma, 43121 Parma, Italy.
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy.
- Department of Neuroradiology, University Hospital Madrid, 28015 Madrid, Spain.
- Medical Oncology Unit, University Hospital of Parma, 43121 Parma, Italy.
- Medical Oncology and Breast Unit, University Hospital of Parma, 43121 Parma, Italy.
- Radiotherapy Unit, University Hospital of Parma, 43121 Parma, Italy.
- Unit of Radiological Sciences, Diagnostic Department, University Hospital of Parma, 43121 Parma, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy.
Abstract
Dynamic contrast-enhanced MRI (DCE-MRI) is emerging as a key technique in neuro-oncologic imaging by enabling quantitative assessment of vascular permeability and blood-brain barrier integrity, two central features of tumor progression and treatment-related tissue injury. Its clinical relevance is particularly evident in the post-treatment setting, where conventional MRI lacks specificity and entities such as tumor progression, pseudoprogression, and radiation necrosis frequently overlap. This narrative review focuses on the role of DCE-MRI in differentiating treatment-related alterations from true tumor progression, primarily in gliomas and, secondarily, in brain metastases and primary CNS lymphoma. We review quantitative and semiquantitative parameters, their biological interpretation, and their diagnostic performance in gliomas, metastases, and primary CNS lymphoma. We further discuss the role of DCE-MRI within multiparametric imaging workflows and highlight emerging contributions from artificial intelligence, radiomics, and automated pharmacokinetic modeling. As a narrative, translational review, this work aims to contextualize DCE-MRI within contemporary neuro-oncologic practice and research. Its clinical translation, however, remains limited by methodological heterogeneity and the lack of standardized acquisition and analysis protocols, highlighting the need for harmonization and prospective multicenter validation.