# Molecular imaging

Source: https://nuclide.cc/fronts/f-molecular-imaging/  
Nuclide record `f-molecular-imaging` (Front). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

Molecular imaging uses a small radioactive tracer injected into the body and a PET or SPECT camera to show where a specific protein sits on a tumour, so doctors can pick the right treatment and check it is working.

## Summary

Molecular imaging is the diagnostic half of theranostics: a radiolabelled ligand binds a target expressed on tumour cells (PSMA, SSTR2, FAP, HER2, CAIX, TROP2 and others) and a PET/CT or PET/MRI camera maps its distribution across the whole body. The field's biggest single deployment is PSMA PET in prostate cancer: the joint EANM/SNMMI PSMA PET/CT procedure guideline 2.0 (Fendler et al., Eur J Nucl Med Mol Imaging 2023) and the 2026 NCCN guidelines now recommend PSMA PET ahead of conventional imaging for unfavourable intermediate- and high-risk staging and for biochemical recurrence, and require it to select patients for PSMA-targeted radioligand therapy. The 2020 proPSMA trial (Hofman et al., Lancet) established the head-to-head case against CT and bone scan.

Somatostatin receptor (SSTR) PET with 68Ga-DOTATATE or DOTATOC plays the equivalent gatekeeping role for peptide receptor radionuclide therapy in neuroendocrine tumours, and FAPI PET is being explored as a pan-cancer stromal imaging agent, though it does not yet have the guideline weight of PSMA or SSTR PET. FDG PET remains the workhorse general-oncology tracer and the comparator against which every newer agent is judged.

What is unsolved in 2026: PSMA expression is heterogeneous and a meaningful fraction of mCRPC patients are PSMA-negative or discordant on biopsy, so imaging-based patient selection is an imperfect proxy for radioligand therapy response; quantitative reporting (SUV, PROMISE/miTNM, E-PSMA) is still not uniformly applied across sites; and reimbursement for newer PET tracers lags their guideline recommendation in several health systems. Total-body PET and AI-assisted reading are being investigated to cut dose and scan time but are not yet standard of care.

## Fields

- Kind: Front
- Last checked: 2026-09-22

## Notes

- PSMA-negative or discordant disease on biopsy is not resolved by better tracers alone; it is a biology problem, not a chemistry one.
- Quantitative reporting frameworks (PROMISE/miTNM, E-PSMA) exist but adoption across sites is uneven, which limits cross-trial comparability.
- Reimbursement for newer PET agents (e.g. flotufolastat, PSMA-1007) trails clinical guideline endorsement in several countries.

## Sources

- EANM/SNMMI: PSMA PET/CT procedure guideline 2.0 (Eur J Nucl Med Mol Imaging, 2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC10027805/
- proPSMA trial (Hofman et al., Lancet 2020): https://pmc.ncbi.nlm.nih.gov/articles/
- PMC: Future opportunities and nuances with PSMA PET (2026 review, incl. 2026 NCCN guidance): https://pmc.ncbi.nlm.nih.gov/articles/PMC13141699/

## Connected records

- fronts: [Cardiac imaging](https://nuclide.cc/fronts/f-cardiac-imaging/), [Dosimetry](https://nuclide.cc/fronts/f-dosimetry/), [Infection & inflammation imaging](https://nuclide.cc/fronts/f-infection-imaging/), [Neuro-imaging](https://nuclide.cc/fronts/f-neuro-imaging/), [Radioligand therapy](https://nuclide.cc/fronts/f-radioligand-therapy/)
- isotopes: [Gallium-68](https://nuclide.cc/isotopes/ga-68/)
- indications: [Biochemical recurrence of prostate cancer](https://nuclide.cc/indications/prostate-bcr/), [Localised prostate cancer, high and very high risk](https://nuclide.cc/indications/prostate-high-risk/), [Neuroendocrine tumours](https://nuclide.cc/indications/neuroendocrine/), [Prostate cancer](https://nuclide.cc/indications/prostate/), [Renal cell carcinoma](https://nuclide.cc/indications/rcc/)
- technologies: [CAIX PET (89Zr-girentuximab)](https://nuclide.cc/technologies/caix-pet/), [FAPI PET](https://nuclide.cc/technologies/fapi-pet/), [FDG PET](https://nuclide.cc/technologies/fdg-pet/), [HER2 PET](https://nuclide.cc/technologies/her2-pet/), [Immuno-PET](https://nuclide.cc/technologies/immuno-pet/), [PET/CT](https://nuclide.cc/technologies/pet-ct/), [PET/MRI](https://nuclide.cc/technologies/pet-mri/), [PSMA PET](https://nuclide.cc/technologies/psma-pet/), [Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC)](https://nuclide.cc/technologies/quantitative-imaging-biomarkers/), [Somatostatin receptor PET (68Ga/64Cu-DOTATATE)](https://nuclide.cc/technologies/sstr-pet/), [Total-body PET for screening and ultra-low-dose imaging](https://nuclide.cc/technologies/total-body-pet-screening/), [TROP2 PET](https://nuclide.cc/technologies/trop2-pet/)
- drugs: [Flotufolastat F-18](https://nuclide.cc/drugs/flotufolastat/), [Fludeoxyglucose F-18 (FDG)](https://nuclide.cc/drugs/fludeoxyglucose-f18/), [Fluoroestradiol F-18 (FES PET)](https://nuclide.cc/drugs/fluoroestradiol-f18/), [Gallium-68 DOTATATE (and Cu-64 DOTATATE)](https://nuclide.cc/drugs/ga68-dotatate/), [Gallium-68 gozetotide (PSMA-11)](https://nuclide.cc/drugs/ga68-psma-11/), [Illuccix (kit for Ga-68 gozetotide)](https://nuclide.cc/drugs/illuccix/), [Locametz (kit for Ga-68 gozetotide)](https://nuclide.cc/drugs/locametz/), [Piflufolastat F-18 / Pylarify TruVu](https://nuclide.cc/drugs/pylarify/), [PSMA-1007 F-18](https://nuclide.cc/drugs/psma-1007-f18/), [Zirconium-89 girentuximab](https://nuclide.cc/drugs/girentuximab-zr89/)
- companies: [Blue Earth Diagnostics (Bracco)](https://nuclide.cc/companies/blue-earth-diagnostics/), [Curium](https://nuclide.cc/companies/curium/), [GE HealthCare](https://nuclide.cc/companies/ge-healthcare/), [Isotopia Molecular Imaging](https://nuclide.cc/companies/isotopia/), [Lantheus](https://nuclide.cc/companies/lantheus/), [Novartis](https://nuclide.cc/companies/novartis/), [Siemens Healthineers](https://nuclide.cc/companies/siemens-healthineers/), [SOFIE Biosciences](https://nuclide.cc/companies/sofie-biosciences/), [Telix Pharmaceuticals](https://nuclide.cc/companies/telix/), [United Imaging](https://nuclide.cc/companies/united-imaging/)
- terms: [Standardised uptake value (SUV)](https://nuclide.cc/terms/suv/), [Theranostics](https://nuclide.cc/terms/theranostics/)
- trials: [proPSMA](https://nuclide.cc/trials/propsma/)

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