Clinical management in neuro-oncology has changed to an integrative approach that incorporates molecular profiles alongside histopathology and imaging findings. While the World Health Organization (WHO) guideline recommends the genotyping of informative alterations as a routine clinical practice for central nervous system (CNS) tumors, the acquisition of tumor tissue in the CNS is invasive and not always possible. Liquid biopsy is a non-invasive approach that provides the opportunity to capture the complex molecular heterogeneity of the whole tumor through the detection of circulating tumor biomarkers in body fluids, such as blood or cerebrospinal fluid (CSF). Despite all of the advantages, the low abundance of tumor-derived biomarkers, particularly in CNS tumors, as well as their short half-life has limited the application of liquid biopsy in clinical practice. Thus, it is crucial to identify the factors associated with the presence of these biomarkers and explore possible strategies that can increase the shedding of these tumoral components into biological fluids. In this review, we first describe the clinical applications of liquid biopsy in CNS tumors, including its roles in the early detection of recurrence and monitoring of treatment response. We then discuss the utilization of imaging in identifying the factors that affect the detection of circulating biomarkers as well as how image-guided interventions such as focused ultrasound can help enhance the presence of tumor biomarkers through blood–brain barrier (BBB) disruption.
神经肿瘤的临床管理已转变为一种整合性方法，将分子特征与组织病理学和影像学发现相结合。尽管世界卫生组织（WHO）指南建议将信息性改变的基因分型作为中枢神经系统（CNS）肿瘤的常规临床实践，但获取CNS肿瘤组织具有侵入性，且并非总是可行。液体活检是一种非侵入性方法，通过检测体液（如血液或脑脊液）中的循环肿瘤生物标志物，为捕捉整个肿瘤的复杂分子异质性提供了机会。尽管具有诸多优势，但肿瘤来源的生物标志物丰度低（尤其是在CNS肿瘤中）及其半衰期短，限制了液体活检在临床实践中的应用。因此，识别与这些生物标志物存在相关的因素，并探索可能增加这些肿瘤成分释放到体液中的策略至关重要。在本综述中，我们首先描述了液体活检在CNS肿瘤中的临床应用，包括其在早期检测复发和监测治疗反应中的作用。然后，我们讨论了影像学在识别影响循环生物标志物检测因素方面的应用，以及聚焦超声等影像引导干预如何通过破坏血脑屏障（BBB）来增强肿瘤生物标志物的存在。
Adding Value to Liquid Biopsy for Brain Tumors: The Role of Imaging
肿瘤(癌症)患者之家