{"entity":{"id":"molecular-imaging-roadmap","kind":"roadmap","name":"Molecular imaging roadmap: FDG → PSMA → FAP → antigen and immune PET","aka":[],"tldr":"From a sugar tracer that lights up most cancers to tracers that show a single protein, a stromal cell type, or the immune cells inside a tumour.","summary":"The molecular imaging roadmap moves from PET scanners and FDG, made routine by PET/CT, to receptor tracers such as 68Ga-DOTATATE and PSMA PET that outperform anatomic imaging and enable theranostics. The current step adds stromal FAPI PET and total-body scanners, and the emerging step brings drug-target and immune PET: TROP2, HER2, B7-H3 and Nectin-4 tracers to select and sequence ADCs, CD8 and granzyme PET to monitor immunotherapy, and PARP PET. The speculative end is multi-tracer same-day imaging, PET-guided adaptive radiotherapy and imaging-derived digital twins. Each new tracer converts a biopsy biomarker into a whole-body map; the route sits in the Imaging section and links PET, PET/CT, FDG PET, PSMA PET, FAPI PET, TROP2 PET, HER2 PET, immuno-PET, PARP PET and PET/MRI.","asOf":"2026-09-04","links":[{"label":"VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer (New England Journal of Medicine 2021)","url":"https://doi.org/10.1056/NEJMoa2107322"},{"label":"DETECT-A: a blood test plus PET-CT found treatable cancers in 10,000 women with no symptoms (Science 2020)","url":"https://doi.org/10.1126/science.abb9601"}],"tags":[],"related":["prostate-roadmap"],"cancers":[],"sections":["imaging"],"technologies":["pet","pet-ct","fdg-pet","psma-pet","fapi-pet","trop2-pet","her2-pet","immuno-pet","parp-pet","pet-mri"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"steps":[{"era":"1975-2001","title":"PET and FDG","description":"PET scanners (1975) and FDG (1976) developed; FDG PET adopted for lymphoma, lung, melanoma staging in the 1990s; PET/CT (2001) makes it routine.","refs":["fdg-pet","pet-ct"],"status":"historic"},{"era":"2008-2020","title":"Receptor PET: SSTR and PSMA","description":"68Ga-DOTATATE (Netspot 2016) and 68Ga/18F-PSMA (2020-21) show receptor tracers outperform anatomic imaging and enable theranostics.","refs":["psma-pet","sstr2"],"status":"historic"},{"era":"2018-2026","title":"Stromal PET and total-body scanners","description":"FAPI tracers image >90% of epithelial cancers with high contrast; registrational trials underway. Total-body PET (uEXPLORER, Quadra) enables 40x sensitivity, low-dose paediatric and dynamic imaging. 18F-FES (ER) approved 2020; 89Zr-girentuximab (CAIX) filed. Pylarify TruVu approved 2026.","refs":["fapi-pet","pet-ct","united-imaging","pylarify"],"status":"current"},{"era":"2024-2028","title":"Drug-target and immune PET","description":"TROP2, HER2, B7-H3, Nectin-4 antibody and nanobody tracers to select and sequence ADCs; CD8 and granzyme PET to predict and monitor immunotherapy response; PARP PET for PARP-inhibitor selection; AI quantification and radiomics on standard scans.","refs":["trop2-pet","her2-pet","immuno-pet","parp-pet","radiology-ai-screening"],"status":"emerging"},{"era":"2028+","title":"Speculative","description":"Multi-tracer same-day imaging on total-body PET; PET-guided adaptive radiotherapy (biology-guided RT); routine antigen PET before every ADC; imaging-derived digital twins of tumour heterogeneity feeding treatment algorithms.","refs":["reflexion","trop2-pet-to-adc"],"status":"speculative"}],"watch":[]},"route":"/roadmaps/molecular-imaging-roadmap/","neighbours":{"roadmap":[{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"section":[{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"radiology-ai-screening","kind":"technology","name":"AI in radiology","route":"/technologies/radiology-ai-screening/"},{"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":"parp-pet","kind":"technology","name":"PARP PET","route":"/technologies/parp-pet/"},{"id":"pet","kind":"technology","name":"PET (positron emission tomography)","route":"/technologies/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":"trop2-pet","kind":"technology","name":"TROP2 PET","route":"/technologies/trop2-pet/"}],"target":[{"id":"sstr2","kind":"target","name":"Somatostatin receptor 2","route":"/targets/sstr2/"}],"company":[{"id":"reflexion","kind":"company","name":"RefleXion Medical","route":"/companies/reflexion/"},{"id":"united-imaging","kind":"company","name":"United Imaging","route":"/companies/united-imaging/"}],"drug":[{"id":"pylarify","kind":"drug","name":"Piflufolastat F-18 / Pylarify TruVu","route":"/drugs/pylarify/"}],"pairing":[{"id":"trop2-pet-to-adc","kind":"pairing","name":"TROP2 PET → TROP2 ADC selection","route":"/pairings/trop2-pet-to-adc/"}]}}