Abstract: Myocardial fibrosis (MF) is a prevalent pathological alteration in a multitude of myocardial diseases. Presistent fibrosis leads to incremental destruction of cardiac structure and decreasing cardiac function, which is one of the important pathophysiological mechanisms in the development of heart failure. Therefore, early detection of MF and comprehension of its dynamic changes are essential for cardiac diseases diagnosis, therapy planning, efficacy evaluation, and prognosis assessment. MF imaging has entered a new phase because of the use of medical imaging technology, particularly nuclear medicine molecular imaging to evaluate alterations at the molecular and cellular levels of the disease. The authors reviewed noninvasive screening methods for MF, especially focusing on the research progress and challenges of nuclear medicine molecular imaging technology in MF, with a view to provide a basis for early diagnosis and accurate assessment of MF, and at the same time, promoting the clinical application and standardisation of nuclear medicine molecular imaging technology, and providing a new direction for the exploration of the mechanisms related to MF and targeted therapeutic strategies.