Immuno-positron emission tomography in cardiovascular disease: Advances, challenges, and opportunities

Cardiovascular diseases involve complex immune-associated biological processes that remain difficult to characterize using conventional imaging approaches. Although positron emission tomography (PET) has emerged as an important molecular imaging modality in cardiology, current metabolic tracers often lack sufficient specificity and may be limited by nonspecific myocardial uptake. Immuno-PET, which combines antibody-based targeting agents with the sensitivity and quantitative capability of PET, offers a promising strategy for noninvasive characterization of cardiovascular biology. In this review, we discuss emerging immuno-PET targets relevant to cardiovascular disease, including pan-leukocyte, lymphocyte-associated, myeloid/macrophage-associated, and vascular activation markers. We additionally review key technical and translational considerations for cardiovascular immuno-PET, including probe design, tissue penetration, blood clearance, radionuclide selection, and target-to-background limitations. Together, recent advances in antibody engineering, nanobody development, radiochemistry, and immune-target discovery are rapidly expanding the potential of immuno-PET for precision imaging of cardiovascular disease.