Extracellular vesicles (EVs) are lipid bilayer-enclosed nanostructures produced by all cells and present in various body fluids. They facilitate cell-to-cell communication by transferring nucleic acids, proteins, carbohydrates, and metabolites. EVs have low immunogenicity and inherent stability, but face challenges in clinical application due to immune clearance, production, and in vivo behavior. This perspective discusses EVs' roles in cellular imaging and drug delivery for disease treatment, along with strategies to overcome their limitations. EVs are classified into microvesicles and exosomes, with exosomes derived from endosomes and microvesicles from plasma membrane budding. EVs are abundant in body fluids and can be isolated using various methods, though challenges remain in purity and yield. EVs contain diverse biomolecules, including DNA, RNA, and lipids, and have potential in drug delivery and theranostics. EVs offer advantages over synthetic nanocarriers like liposomes, including biocompatibility, nonimmunogenicity, and ability to cross biological barriers. EV-based drug delivery systems can be engineered with targeting agents, nanomaterials, or synthetic liposomes for enhanced efficacy. EVs have shown promise in treating diseases such as cancer, neurodegenerative disorders, and cardiovascular conditions. However, challenges remain in scaling production, ensuring safety, and understanding their long-term effects. EVs also have potential in personalized medicine, with autologous EVs offering genetic compatibility. Despite their potential, EVs require further research to address issues such as manufacturing standards, safety, and clinical translation. EVs are being explored for imaging and therapeutic applications, with strategies involving surface modification, targeting agents, and multimodal imaging. The future of EV-based therapies depends on overcoming challenges in production, safety, and clinical validation.Extracellular vesicles (EVs) are lipid bilayer-enclosed nanostructures produced by all cells and present in various body fluids. They facilitate cell-to-cell communication by transferring nucleic acids, proteins, carbohydrates, and metabolites. EVs have low immunogenicity and inherent stability, but face challenges in clinical application due to immune clearance, production, and in vivo behavior. This perspective discusses EVs' roles in cellular imaging and drug delivery for disease treatment, along with strategies to overcome their limitations. EVs are classified into microvesicles and exosomes, with exosomes derived from endosomes and microvesicles from plasma membrane budding. EVs are abundant in body fluids and can be isolated using various methods, though challenges remain in purity and yield. EVs contain diverse biomolecules, including DNA, RNA, and lipids, and have potential in drug delivery and theranostics. EVs offer advantages over synthetic nanocarriers like liposomes, including biocompatibility, nonimmunogenicity, and ability to cross biological barriers. EV-based drug delivery systems can be engineered with targeting agents, nanomaterials, or synthetic liposomes for enhanced efficacy. EVs have shown promise in treating diseases such as cancer, neurodegenerative disorders, and cardiovascular conditions. However, challenges remain in scaling production, ensuring safety, and understanding their long-term effects. EVs also have potential in personalized medicine, with autologous EVs offering genetic compatibility. Despite their potential, EVs require further research to address issues such as manufacturing standards, safety, and clinical translation. EVs are being explored for imaging and therapeutic applications, with strategies involving surface modification, targeting agents, and multimodal imaging. The future of EV-based therapies depends on overcoming challenges in production, safety, and clinical validation.