Long axial field-of-view (LAFOV) PET in the era of multi-parametric imaging and theranostics

This review explores the revolutionary impact of long axial field-of-view (LAFOV) PET/CT imaging in modern nuclear medicine and molecular imaging. LAFOV PET offers extended axial fields-of-view from 50 cm to 200 cm with unprecedented 3D sensitivity, enabling ultra-fast scans at regular doses or ultra-low dose scans at regular scan times as well as simultaneous whole-body dynamic imaging. We discuss the potential of these specifications in facilitating the clinical translation of multi-parametric whole-body PET imaging for superior quantification, lesion detectability, and treatment response assessments across a diverse range of clinical diagnostic and treatment response assessment applications, in oncology, cardiovascular diseases, inflammatory diseases, neurology as well as for systemic multi-organ assessments and other novel imaging applications. Furthermore, we present LAFOV PET's crucial role for optimizing personalized radionuclide therapy via quantitative precision dosimetry and development of theranostic digital twins. Challenges, such as high acquisition costs, large data volumes, and the need for more extensive validation and wider equitable adoption by enhancing cost-effectiveness through novel detector configurations, innovative data-driven correction methods and Artificial Intelligence are also discussed. Ultimately, LAFOV PET has the potential to redefine precision diagnostics and theranostics in nuclear medicine but its currently limited accessibility should be democratized to disseminate its benefits globally and equitably.