Noninvasive Imaging of Nanomedicines and Nanotheranostics: Principles, Progress, and Prospects.

Noninvasive imaging is used for many different (pre)clinical purposes, ranging from disease diagnosis, disease staging, and treatment monitoring to the visualization and quantification of nanomedicine-mediated drug targeting and (triggered) drug release. Noninvasive imaging can be employed to visualize and quantify how efficient passive or active drug targeting is in individual patients and, on this basis, to preselect patients likely to respond to nanomedicine-based chemotherapeutic interventions. In addition, it can be used to visualize the off-target localization of nanomedicines, e.g., in potentially endangered healthy tissues, which under certain circumstances might lead to exclusion from targeted treatment. Moreover, by systematically integrating imaging also during follow-up and by closely monitoring therapeutic responses upon nanomedicine treatment, clinical decision making can be facilitated and improved, as decisions on whether or not to (dis)continue treatment and on whether or not to adjust drug doses can be made relatively early on. Noninvasive imaging may be particularly useful in the case of metastatic disease. By subsequently performing PET or SPECT scans with radionuclide-labeled nanomedicines, information can be obtained on the accumulation of these formulations in both primary tumors and metastases, and treatment protocols can be adapted accordingly.