Abstract: Gliomas are the most common malignant tumors of the central nervous system. Postoperative combined chemoradiotherapy has become a standard part of the treatment, and MRI examination is a routine means to follow-up intracranial lesions. Imaging changes during follow-up should reflect the difference between true progression and pseudoprogression for appropriate clinical decision-making. However, this differentiation is still unclear. Recent studies have found that MGMT promoter, isocitrate dehydrogenase-1 (IDH1), and 1p/19q molecular markers are correlated with pseudoprogression. This combination of molecular biology and imaging for differentiation between true progression and pseudoprogression merits further exploration. This review based on the current research status and the role of MGMT promoter, IDH1, and 1p/19q molecular markers in differentiating between true progression and pseudoprogression, provides a new reference for clinical identification and precision medicine.