Regenerative medicine is the branch of medicine that develops methods to regrow, repair or replace damaged or diseased cells, organs or tissues. Regenerative medicine seeks to be long-term curative, differentiating itself from other clinical therapies that focus primarily on treating symptoms of diseases or mitigating impact of injurie. Regenerative medicine currently includes four main foci: 1) In situ tissue engineering 2) Cellular therapies 3) Ex situ tissue engineering, essentially comprising artificial organs 4) Hybrid biological devices The use of advanced imaging technologies has increased significantly in the past two decades and has revolutionized patients’ care by enabling earlier and more accurate diagnoses. Indeed, for MRI alone, in the USA there are ~ 13,500 MRI sites performing over 35 million MRI scans annually, ~15,000 CT scanners performing 92 million CT scans (2019 numbers, OECD.org), and ~ 2400 PET installations performing ~ 2 million PET procedures (2015 numbers, IMVinfo.com) illustrating the instrumental role that medical imaging plays in our lives. Essentially, no critical medical decisions are taken without relying on some sort of imaging. Furthermore, biomedical imaging plays a crucial role in research and development of novel therapeutics, including in regenerative medicine, at all stages from idea conception through preclinical testing through translational and clinical trials. Imaging in regenerative medicine can be broken into many subcategories, but it may be useful to distinguish at first between biomedical imaging during research and development of new therapeutic approaches and clinical imaging. In general, preclinical imaging is performed strictly using preclinical imaging systems in cellular and small animal subjects, while clinical implementation of regenerative medicine is or will be performed on humans, with imaging taking place using clinical systems. Key milestones for using imaging in regenerative medicine at the preclinical stage include the major facets of the development phase, but also safety considerations. Key milestones of clinical imaging include surgical planning, definition of implantation site, and long-term monitoring. Still speaking generally, and independent of preclinical or clinical imaging, imaging in regenerative medicine can also be divided into imaging native biomarkers or exogenous imageable substances. Native imageable biomarkers would include basic structural and anatomical features one expects to replace or repair, metabolic signatures one expects to measure in function organs, and functional actions one expects to see in normally functioning organs. Exogenous imageable substrates can include impregnated imageable atoms or nanoparticles or can include systemically delivered, internally accumulated chemicals, mediated by normal or engineered metabolic machinery, or via indirectly or directly detected engineered reporter genes. Though this is an MRI conference, this educational lecture will provide a multimodal view of imaging in regenerative medicine. Indeed, the vastness of regenerative medicine requires a complete toolbelt to properly survey the completeness of research and development topics, and clinical methodologies for following treatments. This lecture will survey the uses of multimodal imaging in regenerative medicine, focusing on the benefits of individual imaging methodologies for probing specific research and development questions, and will provide my opinion on how these various imaging technologies might be used clinically.

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References

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