{"entity":{"id":"f-molecular-imaging","kind":"section","name":"Molecular imaging","aka":[],"tldr":"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.\n\nSomatostatin 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.\n\nWhat 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.","asOf":"2026-09-22","links":[{"label":"EANM/SNMMI: PSMA PET/CT procedure guideline 2.0 (Eur J Nucl Med Mol Imaging, 2023)","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10027805/"},{"label":"proPSMA trial (Hofman et al., Lancet 2020)","url":"https://pmc.ncbi.nlm.nih.gov/articles/"},{"label":"PMC: Future opportunities and nuances with PSMA PET (2026 review, incl. 2026 NCCN guidance)","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13141699/"}],"tags":[],"related":["f-radioligand-therapy","f-dosimetry","ga-68"],"indications":["prostate","prostate-bcr","prostate-high-risk","neuroendocrine","rcc"],"sections":[],"technologies":["psma-pet","sstr-pet","fdg-pet","fapi-pet","pet-ct","pet-mri","immuno-pet","caix-pet","her2-pet","trop2-pet","quantitative-imaging-biomarkers","total-body-pet-screening"],"targets":[],"drugs":["ga68-psma-11","pylarify","flotufolastat","psma-1007-f18","ga68-dotatate","fludeoxyglucose-f18","girentuximab-zr89","fluoroestradiol-f18","illuccix","locametz"],"companies":["telix","lantheus","curium","blue-earth-diagnostics","novartis","ge-healthcare","siemens-healthineers","united-imaging","isotopia","sofie-biosciences"],"institutions":[],"pathways":[],"terms":["suv","theranostics"],"trials":["propsma"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"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."],"order":1},"route":"/fronts/f-molecular-imaging/","neighbours":{"section":[{"id":"f-cardiac-imaging","kind":"section","name":"Cardiac imaging","route":"/fronts/f-cardiac-imaging/"},{"id":"f-dosimetry","kind":"section","name":"Dosimetry","route":"/fronts/f-dosimetry/"},{"id":"f-infection-imaging","kind":"section","name":"Infection & inflammation imaging","route":"/fronts/f-infection-imaging/"},{"id":"f-neuro-imaging","kind":"section","name":"Neuro-imaging","route":"/fronts/f-neuro-imaging/"},{"id":"f-radioligand-therapy","kind":"section","name":"Radioligand therapy","route":"/fronts/f-radioligand-therapy/"}],"isotope":[{"id":"ga-68","kind":"isotope","name":"Gallium-68","route":"/isotopes/ga-68/"}],"indication":[{"id":"prostate-bcr","kind":"indication","name":"Biochemical recurrence of prostate cancer","route":"/indications/prostate-bcr/"},{"id":"prostate-high-risk","kind":"indication","name":"Localised prostate cancer, high and very high risk","route":"/indications/prostate-high-risk/"},{"id":"neuroendocrine","kind":"indication","name":"Neuroendocrine tumours","route":"/indications/neuroendocrine/"},{"id":"prostate","kind":"indication","name":"Prostate cancer","route":"/indications/prostate/"},{"id":"rcc","kind":"indication","name":"Renal cell carcinoma","route":"/indications/rcc/"}],"technology":[{"id":"caix-pet","kind":"technology","name":"CAIX PET (89Zr-girentuximab)","route":"/technologies/caix-pet/"},{"id":"fapi-pet","kind":"technology","name":"FAPI PET","route":"/technologies/fapi-pet/"},{"id":"fdg-pet","kind":"technology","name":"FDG PET","route":"/technologies/fdg-pet/"},{"id":"her2-pet","kind":"technology","name":"HER2 PET","route":"/technologies/her2-pet/"},{"id":"immuno-pet","kind":"technology","name":"Immuno-PET","route":"/technologies/immuno-pet/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"},{"id":"pet-mri","kind":"technology","name":"PET/MRI","route":"/technologies/pet-mri/"},{"id":"psma-pet","kind":"technology","name":"PSMA PET","route":"/technologies/psma-pet/"},{"id":"quantitative-imaging-biomarkers","kind":"technology","name":"Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC)","route":"/technologies/quantitative-imaging-biomarkers/"},{"id":"sstr-pet","kind":"technology","name":"Somatostatin receptor PET (68Ga/64Cu-DOTATATE)","route":"/technologies/sstr-pet/"},{"id":"total-body-pet-screening","kind":"technology","name":"Total-body PET for screening and ultra-low-dose imaging","route":"/technologies/total-body-pet-screening/"},{"id":"trop2-pet","kind":"technology","name":"TROP2 PET","route":"/technologies/trop2-pet/"}],"drug":[{"id":"flotufolastat","kind":"drug","name":"Flotufolastat F-18","route":"/drugs/flotufolastat/"},{"id":"fludeoxyglucose-f18","kind":"drug","name":"Fludeoxyglucose F-18 (FDG)","route":"/drugs/fludeoxyglucose-f18/"},{"id":"fluoroestradiol-f18","kind":"drug","name":"Fluoroestradiol F-18 (FES PET)","route":"/drugs/fluoroestradiol-f18/"},{"id":"ga68-dotatate","kind":"drug","name":"Gallium-68 DOTATATE (and Cu-64 DOTATATE)","route":"/drugs/ga68-dotatate/"},{"id":"ga68-psma-11","kind":"drug","name":"Gallium-68 gozetotide (PSMA-11)","route":"/drugs/ga68-psma-11/"},{"id":"illuccix","kind":"drug","name":"Illuccix (kit for Ga-68 gozetotide)","route":"/drugs/illuccix/"},{"id":"locametz","kind":"drug","name":"Locametz (kit for Ga-68 gozetotide)","route":"/drugs/locametz/"},{"id":"pylarify","kind":"drug","name":"Piflufolastat F-18 / Pylarify TruVu","route":"/drugs/pylarify/"},{"id":"psma-1007-f18","kind":"drug","name":"PSMA-1007 F-18","route":"/drugs/psma-1007-f18/"},{"id":"girentuximab-zr89","kind":"drug","name":"Zirconium-89 girentuximab","route":"/drugs/girentuximab-zr89/"}],"company":[{"id":"blue-earth-diagnostics","kind":"company","name":"Blue Earth Diagnostics (Bracco)","route":"/companies/blue-earth-diagnostics/"},{"id":"curium","kind":"company","name":"Curium","route":"/companies/curium/"},{"id":"ge-healthcare","kind":"company","name":"GE HealthCare","route":"/companies/ge-healthcare/"},{"id":"isotopia","kind":"company","name":"Isotopia Molecular Imaging","route":"/companies/isotopia/"},{"id":"lantheus","kind":"company","name":"Lantheus","route":"/companies/lantheus/"},{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"},{"id":"siemens-healthineers","kind":"company","name":"Siemens Healthineers","route":"/companies/siemens-healthineers/"},{"id":"sofie-biosciences","kind":"company","name":"SOFIE Biosciences","route":"/companies/sofie-biosciences/"},{"id":"telix","kind":"company","name":"Telix Pharmaceuticals","route":"/companies/telix/"},{"id":"united-imaging","kind":"company","name":"United Imaging","route":"/companies/united-imaging/"}],"term":[{"id":"suv","kind":"term","name":"Standardised uptake value (SUV)","route":"/terms/suv/"},{"id":"theranostics","kind":"term","name":"Theranostics","route":"/terms/theranostics/"}],"trial":[{"id":"propsma","kind":"trial","name":"proPSMA","route":"/trials/propsma/"}]}}