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The introduction of computed tomographic and magnetic resonance imaging into clinical practice is among the most important of all advances in the care of patients with brain tumors. Diffuse astrocytomas of the adult cerebral hemispheres are unique among human tumors for the degree to which their imaging features correlate with pathologic characteristics and clinical behavior. However, there is still little understanding of the value of various imaging features in measuring response and progression in brain tumors. This review focuses on some of the unsolved problems in the use of neuroimaging in measuring the response of brain tumors to therapy.