Molecular imaging in nuclear medicine, from biomarkers to theranostics

Nuclear medicine, through SPECT and PET devices and the evolution towards morpho-functional imaging, is a major contributor to developments in personalized medicine by providing quantitative biomarkers of molecular signatures. Radioactive labelling confers optimal sensibility performance with sub-picomolar whole-body detection after the introduction of very small amount of tracer that not disrupts the molecular environment. Molecular imaging biomarkers are developed to select patients, and also in a medico-economic view, to guide, predict and evaluate most appropriate treatments, including emergent therapies, according to the characterization of molecular signature of the disease and of the lesions. This molecular complexity is closely linked to the prognosis of the disease, but also to specific treatments developed to be directed towards a same pathophysiological target for diagnosis and therapy with the concept of companion drugs and theranostics. These various evolutions will require an evolution of the economic model, nowadays overshadowed in France by the advent of ever more varied and complex explorations, and the persistence of a qualitatively unique pricing whose only adjustment variable remains the total number of PET exams performed.