Metabolic perturbation score-based mass spectrometry imaging (MPS-MSI) is proposed to reveal the spatially resolved functional metabolic response associated with disease progression or drug action including metabolism pathways, species, biofunction, or biotransformation. The MPS-MSI enables the exploration of therapeutic or adverse effects, regional heterogeneous responses to drug treatment, possible molecular mechanisms, and even drug potential targets. MPS-MSI was demonstrated to be a promising molecular imaging tool not only for efficacy and safety evaluation but also for molecular mechanism investigation at the early stage of drug research and development.