Porous silicon nanoparticles (PSiNPs) have attracted increasing interest as biomedical probes for drug delivery and imaging. In particular, a set of unique properties including biodegradability, intrinsic photoluminescence, and favorable mesoporous structure providing high drug loading allow PSiNPs to address current challenges of translational nanomedicine. In this review, the important features of PSiNPs considered as a biomedical imaging probe will be concisely discussed along with recent advances in fabrication and theranostic applications. Firstly, an overview of PSiNP fabrication with controllable geometry through top-down or bottom-up strategies is provided. Next, intrinsic photoluminescence, the key element allowing application of PSiNPs as an imaging agent, is highlighted with near-infrared emission and micro-second scale lifetime. Emerging technologies for biodegradable nanomedicine based on PSiNPs are then presented. Advances of PSiNPs for disease treaments including photodynamic and photothermal therapeutics are also discussed to open up potential translational medical strategies. In addition, the versatile surface chemistry and modification of PSiNPs in the context of biomedical applications are extensively discussed. Overall, the promising characteristics of PSiNPs encourage further exploration for biomedical research and translational medical platforms, particularly in biomedical imaging.