Brain tumors can be characterized as a heterogeneous group of neoplasms with a correspondingly wide variation in malignant phenotype and a diverse array of imaging features. Magnetic resonance (MR) imaging with intravenous contrast agent is the test of choice to diagnose and monitor brain tumors before, during, and after therapy. Recent advances in imaging methods such as perfusion MR imaging have the ability to provide quantitative cellular, hemodynamic, and metabolic information that may enhance our understanding of brain tumor biology, help us to better assess treatment response, more accurately determine tumor activity during therapy, and differentiate recurrent tumor from treatment related complications. In this work, we reviewed the technique of magnetic resonance perfusion imaging of brain neoplasms, with an emphasis on its clinical applications and utility. We also reviewed the role of perfusion MR imaging in improving accurate evaluation of brain tumors and monitoring tumors during therapy. Both strengths and shortcomings of perfusion MR imaging over standard anatomic MR imaging were discussed, as well as the important pitfalls of the technique. We also reviewed the technique of contrast-enhanced magnetic resonance perfusion imaging of brain neoplasms, with an emphasis on its clinical applications and utility. We discussed the different techniques available today and their relative merits. Next, the ability of MR perfusion to provide a preoperative assessment of tumor histology was also assessed. In addition, we discussed the role of MR perfusion in helping guide tumor biopsy, and its advantages over more conventional methods. The use of MR perfusion for assessing true lesion extent, in contrast to conventional MR imaging and other MR techniques was also evaluated. Additionally we discussed the role of MR perfusion in differentiating treatment effects, such as radiation necrosis, from tumor recurrence. Finally, the future potential applications of this technology in the setting of novel antiangiogenic therapies for brain tumors were addressed.