Diagnostic imaging and emerging image-guided neurointervention in brain tumors: a narrative review

Brain tumors are heterogeneous neoplasms requiring multidisciplinary management and precise diagnostic and therapeutic strategies. Diagnostic radiology plays a central role in tumor detection, characterization, treatment planning, and surveillance through advanced imaging modalities such as multiparametric magnetic resonance imaging, perfusion imaging, diffusion techniques, spectroscopy, and molecular imaging. Concurrently, image-guided procedures performed across endovascular neurointerventional and neurosurgical workflows, including embolization, laser interstitial thermal therapy, intra-arterial chemotherapy, convection-enhanced delivery, and blood-brain barrier modulation, are expanding minimally invasive options in selected patients. This review synthesizes current and emerging diagnostic radiology and image-guided approaches across major brain tumor types, including glioblastoma, low-grade glioma, metastases, primary central nervous system lymphoma, and meningioma. Furthermore, this review highlights the growing overlap among diagnostic radiology, interventional radiology, and neurosurgical workflows, emphasizes the increasingly central role of imaging in guiding therapy, and identifies the need in which coordinated multidisciplinary workflows should be prospectively evaluated as diagnostic and therapeutic technologies continue to converge. Lastly, this review distinguishes established clinical tools from selectively used and investigational approaches by summarizing evidence level, patient-selection considerations, and barriers to routine implementation.