{"product_id":"imaging-and-image-guided-treatment-for-brain-tumors-what-patients-should-know","title":"Imaging and Image-Guided Treatment for Brain Tumors: What Patients Should Know","description":"\u003cp\u003eThis narrative review examines how diagnostic imaging and image-guided procedures are used across the most common brain tumor types. These types include glioblastoma, low-grade glioma, brain metastases, primary central nervous system lymphoma, and meningioma. The authors describe established tools such as MRI, perfusion imaging, MR spectroscopy, and PET, alongside emerging image-guided treatments such as laser interstitial thermal therapy, convection-enhanced delivery, and blood-brain barrier modulation. The review distinguishes tools that are already standard clinical practice from those that remain selectively used or investigational, and it summarizes evidence levels, patient-selection considerations, and barriers to routine implementation.\u003c\/p\u003e\n\n\u003ch1\u003eImaging and Image-Guided Treatment for Brain Tumors: What Patients Should Know\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eHow This Review Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#glioblastoma\"\u003eGlioblastoma: Conventional Imaging\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#advanced-imaging\"\u003eAdvanced and Molecular Imaging for Glioblastoma\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#image-guided\"\u003eImage-Guided Procedures for Glioblastoma\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#evidence\"\u003eEvidence, Limitations, and Patient Selection\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#future\"\u003eFuture Directions\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eClinical Implications for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eImaging is not only for diagnosis; it guides treatment planning, helps surgeons navigate during operations, and monitors how well treatment is working over time.\u003c\/li\u003e\n\u003cli\u003eConventional MRI and diffusion imaging are standard practice, while perfusion imaging, MR spectroscopy, and amino acid PET are used selectively depending on the clinical question and center availability.\u003c\/li\u003e\n\u003cli\u003eLITT is a minimally invasive option for selected recurrent, deep-seated, or surgically inaccessible tumors; in one analysis it gave survival comparable to repeat surgery with shorter hospital stays.\u003c\/li\u003e\n\u003cli\u003eCED, focused-ultrasound blood-brain barrier opening, glioblastoma embolization, and intra-arterial drug delivery remain investigational, supported mainly by early-phase trials, retrospective series, or nonrandomized comparisons.\u003c\/li\u003e\n\u003cli\u003ePatient selection for image-guided procedures depends on lesion size and location, mass effect, vascular anatomy, prior radiation, steroid dependence, performance status, and multidisciplinary expertise.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eBrain tumors are a diverse group of abnormal growths that cause significant illness and death worldwide. Studies of disease patterns show that these tumors are becoming more common, especially in regions with higher socioeconomic development. Glioblastoma is the most common malignant (cancerous) brain tumor subtype, and meningioma is the most common non-malignant (non-cancerous) subtype.\u003c\/p\u003e\n\n\u003cp\u003eThe overall burden of brain tumors is made worse by how difficult they are to diagnose. The burden is also made worse by how differently they can appear in different patients. Many different medical specialists are needed to manage brain tumors. Diagnostic radiology (medical imaging used to detect and characterize disease) is a core part of caring for patients with brain tumors. It provides essential information for initial detection, differential diagnosis (distinguishing one tumor type from another), tumor characterization, treatment planning, and long-term follow-up.\u003c\/p\u003e\n\n\u003cp\u003eThe American College of Radiology recommends advanced imaging methods for anatomical and functional assessment, surgical planning, and follow-up surveillance. These methods include MRI (magnetic resonance imaging) and perfusion imaging, which measures blood flow in tissue. These methods also include MR spectroscopy, which measures the chemical makeup of tissue. These methods also include PET (positron emission tomography), which measures metabolic activity. These tools allow doctors to accurately map tumor margins, analyze molecular and genetic features of the tumor, and evaluate how well treatment is working.\u003c\/p\u003e\n\n\u003cp\u003eImage-guided neuro-oncology covers several related but distinct areas. Diagnostic neuroradiology provides anatomical, physiological, metabolic, and molecular imaging for diagnosis, treatment planning, and surveillance. Endovascular neurointervention (procedures performed inside blood vessels) includes diagnostic angiography (imaging of blood vessels). Endovascular neurointervention also includes preoperative tumor embolization (blocking blood supply to a tumor). Endovascular neurointervention also includes selected procedures that deliver drugs directly into arteries or temporarily open the blood-brain barrier (BBB, the protective filter between the bloodstream and brain tissue). Neurosurgery-led image-guided procedures include stereotactic biopsy (a precise, image-guided tissue sample). Neurosurgery-led image-guided procedures also include intraoperative MRI-guided resection (surgery guided by real-time MRI). Neurosurgery-led image-guided procedures also include laser interstitial thermal therapy (LITT, which uses heat to destroy tumor tissue). Neurosurgery-led image-guided procedures also include most convection-enhanced delivery (CED) procedures, which infuse drugs directly into brain tissue.\u003c\/p\u003e\n\n\u003cp\u003eCombining these perspectives is justified because technology is advancing rapidly and imaging and interventional techniques are increasingly overlapping in neuro-oncology. Despite this evolution, there is limited published work that brings multidisciplinary workflows together into one cohesive framework. Many contemporary image-guided interventions, including laser interstitial thermal therapy and catheter-based regional therapies, are performed by neurosurgeons but rely fundamentally on advanced imaging platforms. This further underscores the need for an integrated imaging-and-intervention approach.\u003c\/p\u003e\n\n\u003cp\u003eA unified synthesis of current and emerging neuroradiologic and image-guided protocols may enhance diagnostic accuracy, improve treatment planning, and support multidisciplinary decision-making, particularly in complex cases with evolving tumor pathologies. This review examines the use of diagnostic neuroradiology, endovascular neurointervention, and neurosurgery-led image-guided procedures across major common brain tumor types. It is intended as a broad, clinically oriented overview for a general neurology and multidisciplinary neuro-oncology audience, rather than a subspecialty-level technical discussion for neuroradiologists or neuro-oncologists. The authors do not propose a prescriptive or universally applicable operational workflow. Instead, they map how these three areas currently intersect and identify a need for more coordinated workflows to be prospectively evaluated.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow This Review Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThis narrative review was developed with reference to the Scale for the Assessment of Narrative Review Articles (SANRA), a tool for assessing the quality of narrative reviews. The literature search began in December 2025 and was updated repeatedly through July 31, 2026.\u003c\/p\u003e\n\n\u003cp\u003eThe authors searched PubMed\/MEDLINE, Scopus, and Google Scholar from each database's inception through July 31, 2026. Search terms included glioblastoma, low-grade glioma, brain metastases, primary central nervous system lymphoma, and meningioma. The authors also searched for terms related to diagnostic imaging and image-guided intervention. These terms included MRI, diffusion, perfusion, spectroscopy, PET, radiomics, artificial intelligence, intraoperative MRI, LITT, CED, focused ultrasound, blood-brain barrier disruption, intra-arterial therapy, stereotactic biopsy, and embolization.\u003c\/p\u003e\n\n\u003cp\u003eThe authors considered English-language peer-reviewed clinical studies, reviews, consensus statements, and professional-society guidelines relevant to diagnosis, treatment planning, image-guided intervention, or surveillance. They prioritized recent guidelines and clinical studies, while retaining older foundational studies when relevant. Studies without a clear neuro-oncologic application were excluded. The authors also reviewed the reference lists of selected articles for additional sources.\u003c\/p\u003e\n\n\u003cp\u003eConference abstracts and trial registrations were included only when describing preliminary or ongoing approaches, and these were identified accordingly. Because this was a narrative review, formal dual-reviewer screening and standardized risk-of-bias assessment were not performed.\u003c\/p\u003e\n\n\u003ch2 id=\"glioblastoma\"\u003eGlioblastoma: Conventional Imaging\u003c\/h2\u003e\n\n\u003cp\u003eAccording to the 2021 CNS WHO classification (the World Health Organization's system for categorizing brain tumors), glioblastoma refers specifically to an adult-type diffuse glioma. This glioma is IDH-wildtype and classified as CNS WHO grade 4. IDH-wildtype glioblastomas represent approximately 90% of adult glioblastomas and correspond to the entity historically regarded as \"primary\" glioblastoma. These tumors exhibit more aggressive biological behavior and are associated with a poorer prognosis.\u003c\/p\u003e\n\n\u003cp\u003eIn contrast, tumors previously referred to as \"secondary glioblastomas\" are now classified as Astrocytoma, IDH-mutant, CNS WHO grade 4. Although both entities are grade 4 diffuse gliomas, IDH-mutant astrocytomas typically occur in younger adults and are associated with a more favorable prognosis.\u003c\/p\u003e\n\n\u003cp\u003eUnder the current framework, a definitive diagnosis can be established through two distinct pathways. Traditionally, diagnosis is made via classic histopathological features (microscopic tissue characteristics), namely necrosis (dead tissue) and\/or microvascular proliferation (abnormal blood vessel growth), within an IDH-wildtype diffuse astrocytic tumor. Alternatively, an adult-type IDH-wildtype diffuse astrocytic glioma can be upgraded to a CNS WHO grade 4 glioblastoma in the absence of these high-grade histological features. This upgrade applies if the glioma possesses any one of three specific molecular markers:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eTERT promoter mutation (a genetic change in the TERT gene)\u003c\/li\u003e\n  \u003cli\u003eEGFR gene amplification (extra copies of the EGFR gene)\u003c\/li\u003e\n  \u003cli\u003eCombined chromosome 7 gain and chromosome 10 loss (written as +7\/−10)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIt is critical to distinguish these autonomous molecular upgrading criteria from other genetic alterations like CDKN2A\/B homozygous deletion. While CDKN2A\/B deletion serves to upgrade IDH-mutant astrocytomas to grade 4, it is not a standalone diagnostic marker for IDH-wildtype glioblastoma.\u003c\/p\u003e\n\n\u003cp\u003eRegarding conventional imaging, because glioblastomas are often large at the time of diagnosis, MRI estimates tumor size by visualizing gadolinium contrast (a dye) that leaks through tumor blood vessels. MRI features show a heterogeneously enhancing mass on post-contrast T1-weighted imaging, with central necrosis or hemorrhagic (bleeding) components in the tumor core. Surrounding vasogenic edema (swelling caused by fluid leaking from blood vessels) is visible on T2\/FLAIR hyperintensity. On MRI, glioblastomas often exhibit irregular margins and significant mass effect (pressure on surrounding brain tissue), with infiltration into adjacent brain tissue.\u003c\/p\u003e\n\n\u003ch2 id=\"advanced-imaging\"\u003eAdvanced and Molecular Imaging for Glioblastoma\u003c\/h2\u003e\n\n\u003cp\u003eOn perfusion MRI, especially dynamic susceptibility contrast (DSC) imaging, relative cerebral blood volume (rCBV) is elevated in high-grade gliomas such as glioblastoma. This elevation is often secondary to increased levels of new blood vessel formation. rCBV is valuable in distinguishing glioblastoma from other masses such as primary CNS lymphoma, which typically shows low rCBV. Perfusion metrics provide prognostic utility, meaning they correlate with survival rates and can guide biopsy targeting.\u003c\/p\u003e\n\n\u003cp\u003eJohnson et al., in a systematic review, highlighted that perfusion MRI can be used to differentiate true tumor progression from treatment-related imaging changes in suspected progressive glioblastoma. Treatment-related imaging changes are also called pseudoprogression (imaging that looks like tumor growth but is actually treatment effect).\u003c\/p\u003e\n\n\u003cp\u003eMagnetic resonance spectroscopy (MRS) provides chemical and metabolic information about brain masses such as glioblastoma. It does this by comparing levels of N-acetylaspartate (NAA) with choline. Typically, NAA levels are greater than choline in normal brain tissue. However, glioblastoma commonly shows increased choline and decreased NAA, reflecting increased membrane turnover and neuronal loss, respectively.\u003c\/p\u003e\n\n\u003cp\u003eDiffusion weighted imaging (DWI) along with apparent diffusion coefficient (ADC) mapping can analyze cellular density in solid tumors like glioblastoma. Specifically, glioblastoma often demonstrates low ADC values in solid tumor regions, which correlates with high cellular density. DWI with ADC mapping is useful for tumor grading and for distinguishing glioblastoma from metastases and lymphomas. DWI is mainly used as the imaging method to detect progression of previously diagnosed glioblastoma.\u003c\/p\u003e\n\n\u003cp\u003eTreatment response in adult diffuse gliomas is commonly evaluated using criteria developed by the international Response Assessment in Neuro-Oncology (RANO) working group. RANO 2.0 is the principal MRI- and clinically based framework for assessing treatment response in adult high- and lower-grade diffuse gliomas. It evaluates enhancing and nonenhancing tumor components while incorporating clinical status, corticosteroid use, baseline imaging, and confirmatory imaging when apparent progression may represent pseudoprogression.\u003c\/p\u003e\n\n\u003cp\u003eIn contrast, PET RANO 1.0 is the first dedicated framework for amino acid PET-based response assessment. It provides complementary criteria for evaluating metabolic response, stable disease, and progression. Amino acid PET tracers include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\u003cstrong\u003e^18F-fluoroethyl-L-tyrosine (^18F-FET)\u003c\/strong\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003cstrong\u003e^18F-fluoro-L-dihydroxyphenylalanine (^18F-FDOPA)\u003c\/strong\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003cstrong\u003e^11C-methionine (^11C-MET)\u003c\/strong\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese tracers may complement MRI for tumor delineation, biopsy or treatment targeting, and differentiation of recurrent glioma from treatment-related changes. However, tracer availability, acquisition protocols, and interpretive thresholds vary across institutions.\u003c\/p\u003e\n\n\u003cp\u003eIn review of emerging diagnostic therapies, radiomics and artificial intelligence (AI) have shown promising results for predicting treatment response and survival rates in glioblastoma. These promising results apply specifically when radiomics and AI are applied to advanced MRI techniques. Radiomics extracts quantitative features from routine and advanced MRI to capture features like tumor shape, intensity, texture, and heterogeneity beyond what the eye can see. Multiparametric models have shown potential in tracking changes in glioblastoma features over time, thus predicting survival rates, progression, and treatment susceptibility.\u003c\/p\u003e\n\n\u003cp\u003eDedhia et al., in a review consisting of 52 studies and 12,482 patients, found that radiomics improve initial diagnostic assessment. Dedhia et al. also found that radiomics distinguish true progression. Dedhia et al. also found that radiomics enable radiogenomic inference of key molecular signatures without biopsy. Though not yet incorporated on a wide scale clinically, progress in radiomics and artificial intelligence can integrate multiple imaging modalities. This integration can yield higher diagnostic accuracy and more optimal treatment monitoring for brain tumors and other pathologies. However, most reported models remain retrospective (looking back at past data). Routine adoption is limited by heterogeneous acquisition protocols, segmentation variability, limited external validation, and uncertain effects on clinical decision-making.\u003c\/p\u003e\n\n\u003ch2 id=\"image-guided\"\u003eImage-Guided Procedures for Glioblastoma\u003c\/h2\u003e\n\n\u003cp\u003eImage-guided techniques are foundational to contemporary glioblastoma management. While primary treatment of glioblastoma consists of neurosurgical resection (surgery to remove the tumor), selected image-guided procedures may be considered for recurrent, deep-seated, or surgically inaccessible disease. Endovascular specialists may perform selected preoperative embolization or intra-arterial procedures. Stereotactic biopsy, intraoperative MRI-guided resection, LITT, and most CED procedures are primarily neurosurgery-led.\u003c\/p\u003e\n\n\u003cp\u003eAlthough preoperative embolization is not routinely indicated for glioblastoma due to its typically modest vascularity (blood supply), a small recent series suggests a possible benefit. That series suggests selective embolization of dominant feeders may be beneficial in carefully chosen cases. In a 2026 series, Uchida et al. demonstrated that preoperative embolization of glioblastoma feeding arteries provided a clearer surgical field, reduced intraoperative bleeding, and facilitated more precise tumor localization without neurological complications. This supports a possible adjunctive role that requires confirmation in larger comparative cohorts.\u003c\/p\u003e\n\n\u003cp\u003eIntraoperative MRI (iMRI) is an established neurosurgical adjunct used at selected centers during glioma resection. Dural opening, cerebrospinal fluid drainage, edema changes, and tissue removal can produce brain shift (movement of brain tissue during surgery). Because of brain shift, navigation based solely on preoperative imaging may become less accurate as surgery progresses. Intraoperative MRI provides updated anatomic information that can identify residual tumor, correct neuronavigation, and guide additional resection when this can be performed without unacceptable functional risk.\u003c\/p\u003e\n\n\u003cp\u003eAlthough iMRI may improve the extent of resection, its effects on long-term survival and cost-effectiveness remain less certain. Important limitations include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eCapital and maintenance costs\u003c\/li\u003e\n  \u003cli\u003eLimited availability of MRI-equipped operating rooms\u003c\/li\u003e\n  \u003cli\u003eThe need for MRI-compatible instruments and trained personnel\u003c\/li\u003e\n  \u003cli\u003eAnesthesia and workflow complexity\u003c\/li\u003e\n  \u003cli\u003eAdditional operative time\u003c\/li\u003e\n  \u003cli\u003eImage artifacts\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn contrast to iMRI-guided resection, which supplements open surgery, MR-guided LITT is a minimally invasive neurosurgery-led option. MR-guided LITT is used in selected patients with recurrent, deep-seated, or surgically inaccessible tumors when open resection is not feasible or carries substantial morbidity. LITT involves the insertion of a probe, thermometric calibration, and subsequent energy modulation under MR guidance.\u003c\/p\u003e\n\n\u003cp\u003eOverall, LITT grants physicians the ability to use predictive modeling that permits voxel-level temperature mapping, thus improving ablation uniformity and safety, especially in lesions in intricate areas. Studies using LITT have achieved results with as high as an average of 93% of tumor volume treatment in glioblastoma. Available evidence is derived largely from retrospective cohorts, single-center series, and heterogeneous systematic reviews, as randomized comparisons and standardized selection criteria remain limited.\u003c\/p\u003e\n\n\u003cp\u003eInterestingly, analysis has shown that LITT demonstrated comparable overall and progression-free survival to repeat surgical resection in patients with surgically accessible, unifocal first-time recurrent glioblastoma. LITT also offered significantly shorter hospital stays in these patients.\u003c\/p\u003e\n\n\u003cp\u003eConvection enhanced delivery (CED) is an emerging investigational technique that enables direct parenchymal infusion of therapeutic agents, bypassing the blood-brain barrier. Using MR- or CT-guided catheter systems, clinicians can microinfuse treatments such as liposomal or nanoparticle agents, immunotoxins, and viral vectors directly into the tumor. These intratumoral distributions are verified in real time through the use of MR perfusion and diffusion sequences. These sequences have the added benefits of a computational modeling system that actively predicts and minimizes backflow or leakage along the catheter tract.\u003c\/p\u003e\n\n\u003cp\u003eEarly results and reviews have investigated the use of CED for glioblastoma, with promising findings. In 2022, Spinazzi et al. reported the first in-human experience of CED of chemotherapy for recurrent glioblastoma. Their findings demonstrated feasibility of CED, with evidence of sustained intratumoral drug distribution and acceptable safety.\u003c\/p\u003e\n\n\u003cp\u003eHowever, CED possesses limitations, including the heterogeneity of flow through tissues and variability in catheter dwell time. These limitations have led to further research and development into improved catheter designs, such as reflux-resistant tips and optimized infusion systems, to optimize delivery and reduce complications.\u003c\/p\u003e\n\n\u003cp\u003eOther experimental modalities include focused ultrasound mediated blood barrier opening, which aims to generate a transient opening for therapeutic treatments to enter the brain. Microbubble-enhanced transcranial focused ultrasound (MB-FUS) facilitates controlled and localized blood-brain barrier disruption for enhanced drug delivery. A 2021 Phase 0 clinical trial (NCT03322813) demonstrated its potential to safely open the BBB and improve drug delivery to gliomas. Subsequently, a 2025 multicenter Phase 1\/2 study reported favorable safety and [text truncated in original].\u003c\/p\u003e\n\n\u003cp\u003eEndovascular neurointerventional approaches are being investigated as regional adjuncts to systemic therapy for glioblastoma. Intra-arterial drug delivery represents an investigational strategy for delivery of chemotherapy directly through cerebral arteries, thus achieving higher tumor drug concentrations with limited systemic toxicity.\u003c\/p\u003e\n\n\u003cp\u003eMost recently, a 2026 single-center series of 70 patients with newly diagnosed or recurrent glioblastoma found that superselective intra-arterial cerebral infusion of bevacizumab or cetuximab was feasible and safe. This infusion followed osmotic blood–brain barrier disruption. This series reported high procedural success, short hospitalizations, low complication rates, and no procedure-related deaths.\u003c\/p\u003e\n\n\u003cp\u003eA 2025 computer-modeling study evaluated superselective intra-arterial yttrium-90 delivery for recurrent glioblastoma. Two registered early-phase trials are evaluating intra-arterial cetuximab in newly diagnosed glioblastoma and temsirolimus in recurrent high-grade glioma. These trial registrations describe ongoing investigations and are not presented as evidence of clinical efficacy.\u003c\/p\u003e\n\n\u003cp\u003eAlong with treatment use, intra-arterial chemoperfusion was shown to be a safe palliative treatment in patients with primary brain malignancies (predominantly glioblastoma) with no major adverse events. Despite the growing body of studies, systemic reviews have shown that intra-arterial delivery is safe and has the potential to achieve higher local drug concentrations for glioblastoma. However, the scarcity of phase III trials limits the ability to definitively conclude therapeutic benefit.\u003c\/p\u003e\n\n\u003ch2 id=\"evidence\"\u003eEvidence, Limitations, and Patient Selection\u003c\/h2\u003e\n\n\u003cp\u003eConventional MRI and diffusion imaging have established clinical roles in glioblastoma management. Perfusion imaging, MR spectroscopy, and amino acid PET are used selectively depending on the diagnostic question and institutional expertise.\u003c\/p\u003e\n\n\u003cp\u003eiMRI and LITT are selectively used at specialized centers, particularly when lesion location, prior therapy, or operative risk limits conventional resection. CED, focused-ultrasound blood-brain barrier opening, glioblastoma embolization, and intra-arterial drug delivery remain investigational because evidence is dominated by early-phase trials, retrospective series, or nonrandomized comparisons.\u003c\/p\u003e\n\n\u003cp\u003ePatient selection should account for several factors:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eLesion size and location\u003c\/li\u003e\n  \u003cli\u003eMass effect (pressure on surrounding brain tissue)\u003c\/li\u003e\n  \u003cli\u003eVascular anatomy (blood vessel structure)\u003c\/li\u003e\n  \u003cli\u003ePrior radiation\u003c\/li\u003e\n  \u003cli\u003eSteroid dependence\u003c\/li\u003e\n  \u003cli\u003ePerformance status (the patient's overall ability to function)\u003c\/li\u003e\n  \u003cli\u003eThe availability of multidisciplinary expertise\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"future\"\u003eFuture Directions\u003c\/h2\u003e\n\n\u003cp\u003eFuture studies should prospectively compare emerging imaging and image-guided approaches with standard of care. Studies should use consistent MRI protocols and clear definitions of tumor progression, pseudoprogression, and treatment response. [The original article text was truncated at this point.]\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eClinical Implications for Patients\u003c\/h2\u003e\n\n\u003cp\u003eThis review carries several important messages for patients with brain tumors and their families. First, imaging is not just for diagnosis. It guides treatment planning, helps surgeons navigate during operations, and monitors how well treatment is working over time.\u003c\/p\u003e\n\n\u003cp\u003eSecond, not all imaging tools are equally established. Conventional MRI and diffusion imaging are standard practice. Perfusion imaging, MR spectroscopy, and amino acid PET are used selectively, depending on the clinical question and what is available at the treating center. Patients may encounter these terms in their care and should feel comfortable asking their care team why a particular imaging test is being recommended.\u003c\/p\u003e\n\n\u003cp\u003eThird, image-guided treatments such as LITT and CED are expanding the options for patients with tumors that are deep-seated, recurrent, or difficult to reach with open surgery. LITT has shown the ability to treat as much as an average of 93% of tumor volume in glioblastoma. In one analysis, patients with surgically accessible, unifocal first-time recurrent glioblastoma who received LITT had overall and progression-free survival comparable to repeat surgical resection, with significantly shorter hospital stays.\u003c\/p\u003e\n\n\u003cp\u003eFourth, many emerging approaches remain investigational. Intra-arterial drug delivery, focused ultrasound blood-brain barrier opening, and CED are supported mainly by early-phase trials, retrospective series, or nonrandomized comparisons. This means that while these approaches are promising, they have not yet been proven in large randomized trials to improve long-term outcomes.\u003c\/p\u003e\n\n\u003cp\u003eFifth, patient selection matters greatly. Many factors influence whether an image-guided procedure is appropriate for a given patient. These factors include lesion size and location, mass effect, vascular anatomy, prior radiation, and steroid dependence. These factors also include performance status and the availability of multidisciplinary expertise.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations\u003c\/h2\u003e\n\n\u003cp\u003eBased on this review, patients and caregivers may consider the following steps:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003eAsk your care team which imaging tests are standard for your tumor type and which are being used selectively or investigationally.\u003c\/li\u003e\n  \u003cli\u003eIf an image-guided procedure such as LITT or CED is proposed, ask whether it is considered established, selectively used, or investigational at your center.\u003c\/li\u003e\n  \u003cli\u003eAsk how your care team will distinguish true tumor progression from pseudoprogression, since this distinction affects treatment decisions.\u003c\/li\u003e\n  \u003cli\u003eInquire about the availability of multidisciplinary expertise, since complex cases benefit from coordinated input across radiology, interventional radiology, neurosurgery, and neuro-oncology.\u003c\/li\u003e\n  \u003cli\u003eIf you are considering participation in a clinical trial of an emerging image-guided approach, ask about the phase of the trial and what is currently known about safety and efficacy.\u003c\/li\u003e\n  \u003cli\u003eDiscuss the limitations of each approach with your care team, including costs, availability, additional operative time, and the need for specialized equipment or personnel.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat imaging tests are standard for brain tumors, and which are used selectively?\u003c\/h3\u003e\n\u003cp\u003eConventional MRI and diffusion imaging are established standard practice for brain tumor care. Perfusion imaging, MR spectroscopy, and amino acid PET are used selectively, depending on the clinical question and what is available at the treating center. Patients may see these terms in their care and can ask their team why a particular test is being recommended.\u003c\/p\u003e\n\u003ch3\u003eWhat is pseudoprogression, and why does it matter for treatment decisions?\u003c\/h3\u003e\n\u003cp\u003ePseudoprogression is imaging that looks like tumor growth but is actually a treatment-related change. Distinguishing it from true progression matters because it affects treatment decisions. Perfusion MRI can help differentiate true tumor progression from these treatment-related imaging changes in suspected progressive glioblastoma. RANO 2.0 also uses confirmatory imaging when apparent progression may represent pseudoprogression.\u003c\/p\u003e\n\u003ch3\u003eWho might be considered for laser interstitial thermal therapy (LITT)?\u003c\/h3\u003e\n\u003cp\u003eLITT is a minimally invasive, neurosurgery-led option used in selected patients with recurrent, deep-seated, or surgically inaccessible tumors when open resection is not feasible or carries substantial morbidity. In one analysis, patients with surgically accessible, unifocal first-time recurrent glioblastoma who received LITT had overall and progression-free survival comparable to repeat surgical resection, with significantly shorter hospital stays.\u003c\/p\u003e\n\u003ch3\u003eIs convection-enhanced delivery (CED) an established treatment for glioblastoma?\u003c\/h3\u003e\n\u003cp\u003eCED remains an emerging investigational technique. It infuses therapeutic agents directly into brain tissue, bypassing the blood-brain barrier, using MR- or CT-guided catheter systems. In 2022, Spinazzi et al. reported the first in-human experience of CED of chemotherapy for recurrent glioblastoma, showing feasibility with sustained intratumoral drug distribution and acceptable safety. Limitations include heterogeneous tissue flow and variable catheter dwell time.\u003c\/p\u003e\n\u003ch3\u003eWhat does it mean if a procedure is described as investigational?\u003c\/h3\u003e\n\u003cp\u003eInvestigational means the approach is supported mainly by early-phase trials, retrospective series, or nonrandomized comparisons, so it has not yet been proven in large randomized trials to improve long-term outcomes. CED, focused-ultrasound blood-brain barrier opening, glioblastoma embolization, and intra-arterial drug delivery are described this way. If a procedure is proposed, ask whether it is established, selectively used, or investigational at your center.\u003c\/p\u003e\n\u003ch3\u003eWhat factors affect whether an image-guided procedure is appropriate for me?\u003c\/h3\u003e\n\u003cp\u003ePatient selection should account for lesion size and location, mass effect, vascular anatomy, prior radiation, steroid dependence, performance status, and the availability of multidisciplinary expertise. Many factors influence whether an image-guided procedure is appropriate for a given patient. Complex cases may benefit from coordinated input across radiology, interventional radiology, neurosurgery, and neuro-oncology.\u003c\/p\u003e\n\u003ch3\u003eWhat should I ask my care team before joining a clinical trial of an image-guided approach?\u003c\/h3\u003e\n\u003cp\u003eAsk about the phase of the trial and what is currently known about safety and efficacy. Also ask whether the procedure is considered established, selectively used, or investigational at your center, and discuss limitations such as costs, availability, additional operative time, and the need for specialized equipment or personnel. These questions can help you weigh participation.\u003c\/p\u003e\n\u003ch3\u003eWhen should a patient with a brain tumor seek a second opinion before image-guided treatment like LITT or CED?\u003c\/h3\u003e\n\u003cp\u003eSeek a second opinion when an image-guided procedure such as laser interstitial thermal therapy or convection-enhanced delivery is proposed, because these approaches are selectively used or investigational and patient selection depends on lesion size and location, mass effect, vascular anatomy, prior radiation, steroid dependence, performance status, and multidisciplinary expertise. A second review can also clarify whether imaging findings represent true tumor progression or pseudoprogression, since that distinction affects treatment decisions. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Diagnostic imaging and emerging image-guided neurointervention in brain tumors: a narrative review.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Alam Z, Messer T, Maddali A, Heath J, Desai K, Sundararajan S, Monoky D, Reddy B.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor affiliations:\u003c\/strong\u003e Department of Radiology, Hackensack Meridian School of Medicine, Nutley, NJ, United States; Department of Interventional Radiology, Robert Wood Johnson Medical School, New Brunswick, NJ, United States; Department of Radiology, Hackensack University Medical Center, Hackensack, NJ, United States; Clearview Radiology PC, Bayside, NY, United States\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e Frontiers in Radiology, Volume 6, Article 1914188\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e Received 19 June 2026; Revised 03 August 2026; Accepted 14 August 2026; Published 08 September 2026\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e 10.3389\/fradi.2026.1914188\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research. The original article is an open-access publication distributed under the terms of the Creative Commons Attribution License. The original article text was truncated in the source provided, and some sections may be incomplete.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47828059652252,"sku":null,"price":0.0,"currency_code":"KRW","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-imaging-and-image-guided-treatment-for-brain-tumors-what-patients-should-know-hero.png?v=1793168650","url":"https:\/\/diagnosticdetectives.kr\/products\/imaging-and-image-guided-treatment-for-brain-tumors-what-patients-should-know","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}