Non-invasive in vivo molecular imaging technologies are uniquely poised to be able to temporally evaluate vascular adaptations to disease and the impact of new therapies. These technologies have been used to study vascular changes in various forms of cardiovascular and inflammatory disease and cancer. The approaches for studying the macro- or microvasculature with non-invasive imaging go beyond anatomic or perfusion characterization and instead yield information on vascular phenotype by either analyzing novel signal features or using targeted contrast agents that reveal the molecular underpinnings for disease. This talk will review new developments in ultrasound molecular imaging techniques that are likely to have a substantial impact on the understanding of pathophysiology, the development of new therapies, or diagnosis of disease in patients. Topics of focus will include recent advances in molecular imaging for the evaluation of: (1) atherosclerotic disease, (2) tissue inflammation or ischemic injury; and (3) thrombus or prothrombotic environment, (4) angiogenesis and stem cells. The discussion will also include a discussion of how these different approaches may play a role to solve current clinical deficiencies.