Future Perspectives: Metabolic Imaging, Theranostics, and Radiomics

The last decade has provided us with small glimpses into novel futuristic approaches to diagnose and treat soft-tissue sarcomas. New innovative metabolic imaging pathways are emerging providing exotic imaging methods to target specific cell receptors or tumor markers. These techniques provide real-time, in vivo detection of physiological processes on the molecular level and allow measurement of regional radiotracer concentrations. This enables quantification of physiological processes which aids in the diagnosis of disease, monitoring disease progression, and the evaluation of responses the therapeutic interventions. In parallel to the growth of molecular imaging, theranostics are now being developed and utilized to provide precision medical therapies to target specific malignancies with focused treatment sparing surrounding normal tissues. Theranostics denotes the coupling of diagnostic biomarkers with therapeutic agents that share a specific target in diseased cells or tissues. These techniques have the potential to provide a significant leap forward in the therapeutic approach to soft-tissue tumors and substantially improve treatment outcomes. Finally, radiomics is a pioneering approach utilized to mine imaging data to provide improved diagnosis, prognostication, and clinical decision support for soft-tissue sarcomas. These applications permit classification tasks that compute the probability of a case belonging to a specific category, such as benign versus malignant, tumor stage, or the presence or absence of metastases. Practical approaches for implementing a radiomic workflow into routine practice continue to evolve and promise to play an increasing role in clinical decision-making.