Radiogenomic landscape of the hallmarks of cancer

Radiogenomics, by integrating medical imaging and multidimensional genomic data, aims to identify non-invasive imaging biomarkers to aid in deciphering the molecular characteristics of tumors and provide potential support for precision medicine. However, existing research is primarily limited to statistical associations between imaging phenotypes and genes, lacking an explanation of the underlying biological mechanisms behind imaging features. This limitation severely restricts its clinical translation and application. The “hallmarks of cancer” theory proposed by Hanahan and Weinberg provides a core framework for systematically understanding tumor biological behavior. This review, for the first time, systematically associates and interprets radiogenomics with all cancer hallmarks and enabling characteristics, aiming to bridge the gap between imaging phenotypes and tumor biological mechanisms, enhance the biological interpretability of radiogenomics, and promote its advancement towards mechanism-driven precision oncology.