Although anatomical imaging, including CT, MRI and ultrasound, is the most widely utilised approach for detection and staging of phaeochromocytoma and paraganglioma (PCC/PGL), there is increasing recognition of the utility of molecular imaging techniques. The first radiopharmaceutical developed for both the diagnosis and therapy of PCC/PGL was I-131 meta-iodo-benzylguanidine (MIBG), which is taken up by the norepinephrine transporter and stored in neurosecretory granules. Although traditionally labelled with the gamma-emitting radionuclides I-131 and, more recently, I-123, I-124 MIBG PET/CT imaging provides superior sensitivity for detection of small lesions compared to conventional gamma camera imaging due to higher spatial and contrast resolution. Use of PET/CT has the additional advantage of allowing quantitative analysis of tissue retention over time and thereby, estimation of potential radiation dose to tumour and normal tissues if radionuclide therapy is contemplated. Other catecholamine-like compounds that are suitable for PET imaging include C-11 hydroxyephedrine (HED), 18F-Meta Fluorobenzyl Guanidine (MFBG) and F-18 flurodopamine (FDA). Similarly, catecholamine precursors like 18F -L-fluoro-dihydroxyphenylalanine (FDOPA) have also been shown to detect some sites of disease. Like MIBG, these agents have relatively high specificity for Pheo/PGL but all have suboptimal sensitivity, especially for PGL of the head and neck region. Therefore, other aspects of tumour biology have been leveraged for diagnostic purposes or combined diagnostic and therapeutic (“theranostic”) roles. Although non-specific, increased glycolytic metabolism has been shown to be a feature of many Pheo/PGL, especially those arising within the pseudo-hypoxia cluster, which leads to metabolic reprogramming. With the wide clinical availability of FDG PET/CT, this has become a practical alternative to MIBG for detection and staging of these tumours. Similarly, recognition of the frequent expression of somatostatin receptors (SSTR) on Pheo/PGL has also led to the use of radiolabelled somatostatin analogues (SSA), especially 68Ga-DOTA-octreotate for PET imaging. It is obviously not practical to use all these agents for evaluation of known or suspected Pheo/PGL and to a large extent the choice of radiotracer will be determined by local availability and regulatory approvals. Accordingly, there are no generally agreed algorithms that inform the use of these agents. Nevertheless, it is possible to establish rational guidelines regarding for whom, when and with which agent imaging should be considered using a combination of clinical and genomic characteristics of Pheo/PGL syndromes. Increasing understanding of the links between genotype and molecular imaging phenotype will strengthen investigation paradigms with an increasing focus on therapeutic options for patients.