Abstract: Atherosclerotic plaques may rupture without warning and cause acute cardiovascular events such as sudden cardiac death. Unfortunately, current diagnostic tools are insufficient to identify high-risk patients during the early stage of the disease. Molecular imaging brings new opportunity for early plaque diagnosis. Meanwhile, the concept of precision medicine may guide the accurate diagnosis and treatment of atherosclerosis plaques. This review describes the development of molecular imaging with the integration of cardiovascular physiopathology, biomedical engineering and nanotechnology under the concept of precision medicine.