Molecular Imaging in Pancreatic Cancer: Current Applications and Future Perspectives

Pancreatic cancer ranks among the most lethal malignancies, characterized by a five-year survival rate of approximately 10%. This dismal prognosis is largely attributable to diagnoses occurring at advanced stages and the inherent limitations of conventional imaging modalities in detecting early lesions, identifying metastases, and assessing tumor heterogeneity. Consequently, there is a critical need for non-invasive imaging techniques capable of visualizing pancreatic cancer lesions to enable accurate diagnosis, risk assessment, and the development of personalized treatment strategies. Molecular imaging, which combines highly specific targeted probes with advanced imaging technologies, offers the potential to elucidate disease-associated pathways. This review provides a comprehensive overview of recent advancements in molecular imaging platforms for pancreatic cancer, including positron emission tomography (PET), single-photon emission computed tomography (SPECT), optical molecular imaging, photoacoustic imaging, and molecular MRI. We begin by elucidating the biological rationale for targeting key molecules, including fibroblast activation protein (FAP), integrins, and programmed death ligand 1 (PD-L1). Moreover, we critically evaluate the development and clinical translation of these probes, highlighting their ability to enhance lesion detectability, characterize intratumoral heterogeneity, and guide both targeted therapy and surgical resection. Compared with existing reviews, this work uniquely integrates a comprehensive cross-modality analysis of the latest molecular imaging strategies for pancreatic cancer. Furthermore, we examine prevailing challenges and emerging frontiers in this domain, specifically focusing on multimodal hybrid imaging, artificial intelligence-driven analytics, and integrated theranostic platforms as pivotal strategies to advance precision oncology.