Artificial Intelligence Across the PSMA Theranostic Continuum in Prostate Cancer.

Introduction to the special issue of “Advances in Molecular Imaging”

Recent advances in optical molecular imaging allow identification of morphologic and biochemical changes in tissues associated with gastrointestinal (GI) premalignant lesions earlier and in real-time. This focused review series introduces high-resolution imaging modalities that are being evaluated preclinically and clinically for the detection of early GI cancers, especially Barrett esophagus and esophageal adenocarcinoma. Although narrow band imaging, autofluorescence imaging, and chromoendoscopy are currently applied for this purpose in the clinic, further adoptions of probe-based confocal laser endomicroscopy, high-resolution microendoscopy, optical coherence tomography, and metabolomic imaging, as well as imaging mass spectrometry, will lead to detection at the earliest and will guide predictions of the clinical course in the near future in a manner that is beyond current advancements in optical imaging. In this review article, the readers will be introduced to sufficient information regarding this matter with which to enjoy this new era of high technology and to confront science in the field of molecular medical imaging.

Gold nanoparticles (AuNP) have been extensively developed as contrast agents, theranostic platforms, and probes for molecular imaging. This popularity has yielded a large number of AuNP designs that vary in size, shape, surface functionalization, and assembly, to match very closely the requirements for various imaging applications. Hence, AuNP based probes for molecular imaging allow the use of computed tomography (CT), fluorescence, and other forms of optical imaging, photoacoustic imaging (PAI), and magnetic resonance imaging (MRI), and other newer techniques. The unique physicochemical properties, biocompatibility, and highly developed chemistry of AuNP have facilitated breakthroughs in molecular imaging that allow the detection and imaging of physiological processes with high sensitivity and spatial resolution. In this Review, we summarize the recent advances in molecular imaging achieved using novel AuNP structures, cell tracking using AuNP, targeted AuNP for cancer imaging, and activatable AuNP probes. Finally, the perspectives and current limitations for the clinical translation of AuNP based probes are discussed.

Prostate cancer (PCa) is the most frequently diagnosed malignancy in men in developed countries and a leading cause of cancer death worldwide. Effective methods for diagnosing and staging PCa are necessary to guide treatment options in a personalized manner. The purpose of this paper is to review recent advances in molecular imaging and therapeutics and their expanding role in imaging and treating PCa. Compared with conventional imaging, PSMA PET has proven more accurate at detecting PCa in patients with newly diagnosed PCa or biochemically recurrent PCa. PSMA PET can also induce management changes in patients due to its superior accuracy in detecting metastatic disease. Further research is necessary to understand the appropriate role of PSMA PET in patients with known metastatic PCa and the impact on clinical outcomes in patients who undergo treatment planning using findings from PSMA PET. We review the role of molecular imaging in primary and biochemically recurrent PCa. We find that molecular imaging is effective in detecting PCa and may lead to management changes.

Prostate cancer and inflammation: A new molecular imaging challenge in the era of personalized medicine

Non-invasive molecular imaging of prostate cancer lymph node metastasis

Molecular imaging is a newly emerging and rapidly developing biomedical imaging field in which the modern tools are being married to depict noninvasive in vivo cellular and molecular processes sensitively and specifically, such as monitoring multiple molecular events, cell trafficking and targeting. The goals of this field are to develop technologies and instruments for studying biological and medical processes as well as diagnosing and managing diseases better. Although rapid progress in the fundamentals and applications make molecular imaging become an important tool for biomedical research in recent years, many difficult problems and challenges remain. Discussing the problems and challenges in detail and illustrating recent progress and future direction, the special issue collects the high-quality, peer-reviewed, original research papers in the area of molecular imaging. Novel molecular imaging theories and algorithms, new molecular probes, multimodality molecular imaging prototype systems and experiments, and final clinical applications are introduced mainly in this special issue. In molecular imaging theories and algorithms, genetic algorithm-based optimization tool is used to improve the accuracy of the diffusion model in strongly absorbing media by adjusting the optical parameters. Furthermore, a penalized linear and nonlinear combined conjugate gradient method, a fast preiteration algorithm based on the generalized inverse matrix, and a Monte-Carlo-based network method are also proposed for light source reconstruction in optical tomography. Considering the importance of molecular probes, synthesis and bioconjugation of gold nanoparticles as potential molecular probes for light-based imaging techniques are described in this special issue, and the nitroimidazole-based thioflavin-T derivatives as cerebral ischemia markers are evaluated in vivo. In order to test the feasibility and effectiveness of imaging theories, algorithms and probes, molecular imaging prototype systems should be designed, constructed and employed for small animal or phantom imaging. Thus, multimodality fusion near-infrared optical tomography Systems with highly sensitive CCD camera and photomultiplier tube can be consulted respectively in this special issue. Furthermore, a novel confocal optical system design and a dual laser confocal scanner have been developed for molecular imaging applications of biochip. In clinical applications, the advantage of PET and CT integration in examination of lung tumors is analyzed. Moreover, several innovative processing methods of molecular image are also presented in this special issue. In conclusion, this special issue covers recent important advances in molecular imaging field.

Small cell lung cancer (SCLC) is an aggressive pulmonary neuroendocrine carcinoma characterized by rapid progression and early metastasis. Despite recent therapeutic advances, including immune checkpoint inhibitors and emerging targeted agents, survival outcomes remain poor. Recent molecular insights have identified four transcription factor-driven subtypes-SCLC-A, SCLC-N, SCLC-P, and the inflamed subtype SCLC-I-providing a framework for precision and immunotherapy-based strategies. This review summarizes the evolving scope of imaging in SCLC and highlights emerging approaches that support personalized medicine. Conventional imaging with CT, MRI, and fluorine 18 fluorodeoxyglucose PET/CT remains essential for diagnosis, staging, and treatment response assessment. Semiquantitative, volume-based PET/CT metrics, such as metabolic tumor volume and total lesion glycolysis, correlate with tumor proliferation and provide stronger prognostic value than maximum standardized uptake value. Emerging imaging approaches, including radiomics, radiogenomics, and machine learning, may further enable noninvasive tumor characterization and outcome prediction. Recent advances in molecular imaging, including delta-like ligand 3- and somatostatin receptor-targeted immune-PET, represent key steps toward biomarker-guided and personalized therapy. Together, integration of structural, functional, and molecular imaging with biologic insights is expected to shape the next phase of precision oncology in this highly aggressive malignancy. Keywords: Lung, Imaging Modality, PET, MRI, Molecular Imaging, Oncology, Neoplasms-Primary, CT, MR Imaging, Diagnosis, PET/CT, Small Cell Lung Cancer, Radiogenomics, Machine Learning, Radiolabeled Tracer, Personalized Medicine Supplemental material is available for this article. © RSNA, 2026.

Approximately 30% of patients treated with radical prostatectomy (RP) for prostate cancers experience biochemical recurrence (BCR). Post-operative radiation therapy (RT) can be either offered immediately after the surgery in case of aggressive pathological features or proposed early if BCR occurs. Until recently, little data were available regarding the optimal RT timing, protocol, volumes to treat, and the benefit of adding androgen deprivation therapies to post-operative RT. In this review, we aim to pragmatically discuss current literature data on these points. Early salvage RT appears to be the optimal post-operative approach, improving oncological outcomes especially with low prostate-specific antigen (PSA) levels, as well as sparing several unnecessary adjuvant treatments. The standard RT dose is still 64–66 Gy to the prostate bed in conventional fractionation, but hypofractionation protocols are emerging pending on late toxicity data. Several scientific societies have published contouring atlases, even though they are heterogeneous and deserve future consensus. During salvage RT, the inclusion of pelvic lymph nodes is also controversial, but preliminary data show a possible benefit for PSA > 0.34 ng/ml at the cost of increased hematological side effects. Concomitant ADT and its duration are also discussed, possibly advantageous (at least in terms of metastasis-free survival) for PSA rates over 0.6 ng/ml, taking into account life expectancy and cardiovascular comorbidities. Intensified regimens, for instance, with new-generation hormone therapies, could further improve outcomes in carefully selected patients. Finally, recent advances in molecular imaging, as well as upcoming breakthroughs in genomics and artificial intelligence tools, could soon reshuffle the cards of the current therapeutic strategy.

Development of novel imaging probes for cancer diagnostics remains critical for early detection of disease, yet most imaging agents are hindered by suboptimal tumor accumulation. To overcome these limitations, researchers have adapted antibodies for imaging purposes. As cancerous malignancies express atypical patterns of cell surface proteins in comparison to non-cancerous tissues, novel antibody-based imaging agents can be constructed to target individual cancer cells or surrounding vasculature. Using molecular imaging techniques, these agents may be utilized for detection of malignancies and monitoring of therapeutic response. Currently, there are several imaging modalities commonly employed for molecular imaging. These imaging modalities include positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance (MR) imaging, optical imaging (fluorescence and bioluminescence), and photoacoustic (PA) imaging. While antibody-based imaging agents may be employed for a broad range of diseases, this review focuses on the molecular imaging of pancreatic cancer, as there are limited resources for imaging and treatment of pancreatic malignancies. Additionally, pancreatic cancer remains the most lethal cancer with an overall 5-year survival rate of approximately 7%, despite significant advances in the imaging and treatment of many other cancers. In this review, we discuss recent advances in molecular imaging of pancreatic cancer using antibody-based imaging agents. This task is accomplished by summarizing the current progress in each type of molecular imaging modality described above. Also, several considerations for designing and synthesizing novel antibody-based imaging agents are discussed. Lastly, the future directions of antibody-based imaging agents are discussed, emphasizing the potential applications for personalized medicine.

Background: Recent endoscopic studies have revealed that small colorectal tumors are often overlooked during colonoscopy, indicating that more sensitive detection methods are needed. Summary: Molecular imaging has received considerable attention as a new endoscopic technique with high sensitivity. It generally employs a fluorescence-labeled compound that specifically binds to a molecule on the tumor. Fluorescent probes for molecular imaging are largely classified as 2 types: a fluorescence-labeled antibody targeting a molecule specifically expressed on the tumor cell surface such as epidermal growth factor receptor or vascular endothelial growth factor (VEGF); and a fluorescence-labeled small molecule compound targeting a molecule specifically expressed in tumor cells including c-Met, glutathione S-transferase, γ-glutamyltranspeptidase, cathepsin, or endothelin A receptor. These probes successfully detected colorectal tumors in several animal studies. Moreover, 3 recent human clinical trials evaluating endoscopic molecular imaging for colorectal tumors have been reported. In one study, a Cy5-labeled synthetic peptide against c-Met was developed, and fluorescent endoscopic observation with this probe detected a greater number of colorectal adenomas than with white light observation. Another trial used IR800-labeled anti-VEGF antibody, which sensitively detected human colorectal adenomas by fluorescent endoscopy. Last, a fluorescent probe with synthetic peptide against BRAF-positive cells was able to visualize sessile serrated lesions. The fluorescent probes accumulated at very high levels in colorectal tumor cells but at lower levels in surrounding nonneoplastic mucosa. Key Messages: We expect that molecular imaging techniques with fluorescent probes will soon lead to the establishment of a highly sensitive endoscopic method for colorectal tumor detection.

Recent advances in molecular imaging allow us to visualize both cellular and subcellular processes within living subjects at the molecular level as well as at the anatomical level [1]. Molecular imaging is molecular-genetic imaging for visualizing cellular processes by combination of molecular biology and biomedical imaging. This marvelous technique provides research attention not only in molecular cell biology but also in related fields. Remarkable improvement of molecular imaging was achieved in visualization, characterization, and quantification of biological processes by integration of many different fields such as genetics, pharmacology, chemistry, physics, engineering and medicine.

The evolving role of stereotactic ablative radiation therapy (SABR) as metastasis-directed therapy (MDT) for oligometastatic prostate cancer (omPCa) will be discussed. Oligometastatic disease (OMD) is an intermediate state between localized and wide-spread malignant disease. OMD has recently been spotlighted given the increasing demonstration of clinical benefit from local therapies despite presence of metastatic disease and allure of the curative potential of MDT in select cases. Among the different forms of MDT, SABR has rapidly become a widely adopted treatment modality. Significant efforts in this space have focused on omPCa, owing to its relatively indolent biology, presence of a sensitive and specific serum biomarker and recent advances in molecular imaging. While most studies have evaluated the role of SABR MDT in hormone sensitive omPCa, new emerging clinical data also suggests benefits of SABR MDT for even castration-resistant disease. Treating omPCa with SABR MDT appears to generate an efficacy signal with minimal morbidity across both hormone-sensitive and castration-resistant disease. However, additional definitive omPCa trial data are needed. Future research efforts should investigate biomarkers for this heterogeneous disease space and the role of SABR MDT in combination with systemic agents to improve upon standard of care treatments.

The potential of molecular imaging in visualizing pathophysiologic processes underlying the development, progression, and regression of disease makes it a powerful tool for early detection, risk stratification, and tracking response to therapy. We have seen remarkable advances in molecular imaging of vascular diseases in recent years. To date, most studies have addressed the feasibility of molecular imaging in animal models of human disease, and translation into clinical practice is expected in the near future. Although there is a large body of literature, some groundbreaking, on cardiovascular molecular imaging going back to a decade ago, this review mainly focuses on recent advances in molecular imaging of vascular diseases of the heart.

Atherosclerosis is a major cause of ischemic heart disease, and the increasing medical burden associated with atherosclerotic cardiovascular disease has become a major public health concern worldwide. Macrophages play an important role in all stages of the dynamic progress of atherosclerosis, from its initiation and lesion expansion increasing the vulnerability of plaques, to the formation of unstable plaques and clinical manifestations. Early imaging can identify patients at risk of coronary atherosclerotic disease and its complications, enabling preventive measures to be initiated. Recent advances in molecular imaging have involved the noninvasive and semi-quantitative targeted imaging of macrophages and their related molecules in vivo, which can detect atheroma earlier and more accurately than conventional imaging. Multimodal imaging integrates vascular structure, function, and molecular imaging technology to achieve multi-dimensional imaging, which can be used to comprehensively evaluate blood vessels and obtain clinical information based on anatomical structure and molecular level. At the same time, the rapid development of nonmolecular imaging technologies, such as intravascular imaging, which have the unique advantages of having intuitive accuracy and providing rich information to identify macrophage inflammation and inform targeted personalized treatment, has also been seen. In this review, we highlight recent methods and research hotspots in molecular and nonmolecular imaging of macrophages in atherosclerosis that have enormous potential for rapid clinical application.