{"id":"molecular-imaging-roadmap","name":"Molecular imaging roadmap: FDG → PSMA → FAP → antigen and immune PET","route":"/roadmaps/molecular-imaging-roadmap/","eras":[{"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.","status":"historic","refs":[{"id":"fdg-pet","kind":"technology","name":"FDG PET","route":"/technologies/fdg-pet/","status":"standard-of-care","tldr":"FDG PET is the standard PET scan. A radioactive sugar shows which tissues are burning glucose fast, which most cancers do."},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/","status":"standard-of-care","tldr":"PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT."}],"trials":[],"papers":[]},{"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.","status":"historic","refs":[{"id":"psma-pet","kind":"technology","name":"PSMA PET","route":"/technologies/psma-pet/","status":"standard-of-care","tldr":"A prostate-cancer-specific PET scan that finds spread far earlier than CT or bone scan, and tells you whether a matched radioactive drug will work."},{"id":"sstr2","kind":"target","name":"Somatostatin receptor 2","route":"/targets/sstr2/","tldr":"Somatostatin receptor 2 is a hormone receptor densely present on neuroendocrine tumours, and was the first theranostic target to reach routine care."}],"trials":[],"papers":[]},{"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.","status":"current","refs":[{"id":"fapi-pet","kind":"technology","name":"FAPI PET","route":"/technologies/fapi-pet/","status":"phase-3","tldr":"FAPI PET is a PET scan that lights up the scaffolding around almost any solid tumour, including cancers the standard sugar scan misses."},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/","status":"standard-of-care","tldr":"PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT."},{"id":"united-imaging","kind":"company","name":"United Imaging","route":"/companies/united-imaging/","tldr":"Chinese imaging company that built uEXPLORER, the first total-body PET scanner."},{"id":"pylarify","kind":"drug","name":"Piflufolastat F-18 / Pylarify TruVu","route":"/drugs/pylarify/","status":"approved","tldr":"Piflufolastat F-18 (Pylarify) is the leading PSMA PET tracer for prostate cancer, with a new formulation approved in March 2026."}],"trials":[],"papers":[]},{"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.","status":"emerging","refs":[{"id":"trop2-pet","kind":"technology","name":"TROP2 PET","route":"/technologies/trop2-pet/","status":"phase-1","tldr":"An experimental PET scan that shows whether a tumour carries the TROP2 protein, so doctors could pick the right ADC before giving it."},{"id":"her2-pet","kind":"technology","name":"HER2 PET","route":"/technologies/her2-pet/","status":"phase-2","tldr":"HER2 PET is a PET scan using radiolabelled trastuzumab or smaller HER2 binders to map HER2 across all metastases at once."},{"id":"immuno-pet","kind":"technology","name":"Immuno-PET","route":"/technologies/immuno-pet/","status":"phase-2","tldr":"PET scans built from radiolabelled antibodies or their fragments, to see any protein an antibody can reach, including immune cells inside tumours."},{"id":"parp-pet","kind":"technology","name":"PARP PET","route":"/technologies/parp-pet/","status":"phase-2","tldr":"A PET tracer that measures how much of the DNA repair enzyme PARP a tumour has, to predict response to PARP inhibitors."},{"id":"radiology-ai-screening","kind":"technology","name":"AI in radiology","route":"/technologies/radiology-ai-screening/","status":"established","tldr":"Software that reads scans alongside radiologists, catching cancers earlier and predicting who is at risk."}],"trials":[],"papers":[]},{"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.","status":"speculative","refs":[{"id":"reflexion","kind":"company","name":"RefleXion Medical","route":"/companies/reflexion/","tldr":"RefleXion Medical makes the first PET-guided radiotherapy system, which uses the tumour's own emissions to steer the beam."},{"id":"trop2-pet-to-adc","kind":"pairing","name":"TROP2 PET → TROP2 ADC selection","route":"/pairings/trop2-pet-to-adc/","tldr":"Proposed: a TROP2 PET scan to choose between three TROP2 ADCs and predict who will respond, since tissue staining has not worked."}],"trials":[],"papers":[]}],"watch":[]}