Dynamic Contrast-Enhanced MRI in Neuro-Oncology: A Narrative and Translational Review

Background/Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.