Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.

在过去的几十年里，我们对肿瘤生物学的理解不断发展，现在癌症被视为一个复杂的生态系统，肿瘤微环境（TME）内的各种细胞和非细胞成分之间在多个尺度上相互作用。然而，形态学成像仍然是肿瘤分期和治疗反应评估的支柱，并且用非侵入性成像表征 TME 尚未进入常规临床实践。通过组合多个 MRI 序列，每个序列提供有关 TME 的不同但互补的信息，多参数 MRI (mpMRI) 能够对 TME 内的分子和细胞特征进行非侵入性评估，包括其空间和时间异质性。随着越来越多的先进 MRI 技术弥合了临床前和临床应用之间的差距，mpMRI 最终可以指导治疗方法的选择，并针对每个患者、肿瘤和治疗方式进行精确定制。在这篇综述中，我们描述了 mpMRI 在 TME 非侵入性表征中不断发展的作用，概述了其在癌症检测、分期和治疗反应评估中的应用，并讨论了其在未来医疗应用中使用的考虑因素和挑战，包括个性化综合诊断。