For decades now, photoacoustic imaging (PAI) has been
investigated
to realize its potential as a niche biomedical imaging modality. Despite
its highly desirable optical contrast and ultrasonic spatiotemporal
resolution, PAI is challenged by such physical limitations as a low
signal-to-noise ratio (SNR), diminished image contrast due to strong
optical attenuation, and a lower-bound on spatial resolution in deep
tissue. In addition, contrast-enhanced PAI has faced practical limitations
such as insufficient cell-specific targeting due to low delivery efficiency
and difficulties in developing clinically translatable agents. Identifying
these limitations is essential to the continuing expansion of the
field, and substantial advances in developing contrast-enhancing agents,
complemented by high-performance image acquisition systems, have synergistically
dealt with the challenges of conventional PAI. This review covers
the past four years of research on pushing the physical and practical
challenges of PAI in terms of SNR/contrast, spatial resolution, targeted
delivery, and clinical application. Promising strategies for dealing
with each challenge are reviewed in detail, and future research directions
for next generation contrast-enhanced PAI are discussed.