Role of Neuroimaging in Cancer-Treatment Neurotoxicity

As cancer therapies evolve and become increasingly targeted, the spectrum of treatment-related neurotoxicities presents a growing challenge. This Review highlights important neurotoxic complications associated with commonly used and emerging cancer therapies, emphasizing the critical role of neuroimaging in their detection and differentiation from disease progression and other entities. The specific entities considered include neurologic immune-related adverse events, immune effector cell-associated neurotoxicity syndrome, and tumor inflammation-associated neurotoxicity. Imaging techniques, such as perfusion MRI, vessel wall imaging, and amino acid PET, are complementary in improving performance in diagnosing neurotoxicity syndromes and guiding timely clinical decision-making and intervention. A multidisciplinary approach integrating oncology, neurology, and imaging is crucial for balancing therapeutic benefits with neurotoxicity risk. Early recognition and intervention are essential; although many treatment-induced neurotoxicities are reversible, delayed diagnosis can result in long-term disability or even death. By recognizing characteristic imaging patterns, radiologists play a central role in identifying emerging treatment-related neurotoxicity syndromes, thereby supporting safe, high-quality, patient-centered cancer care.