Similar to analog silicon photomultipliers (SiPMs), digital SiPMs (dSiPMs) essentially consist of an array of single-photon avalanche photodiodes (SPADs). Instead of a passive quench resistor, however, an active quenching circuit is locally integrated with each SPAD, making the sensor response faster and less sensitive to the gains of the individual SPADs. Moreover, additional circuits for the fully digital acquisition, processing, and readout of optical signals are integrated within the sensor. As a result, dSiPMs offer high photo-detection efficiency, high single-photon time resolution (SPTR), and high uniformity, as well as many practical advantages, such as a very compact form factor, low voltage operation, magnetic field compatibility, high stability of operation, low gain drift, and a high degree of scalability. At the same time, dSiPMs represent a new paradigm in low-level light sensing technology. That is, their fully digital operation makes them true photon counting devices, preserving at least partly the discrete spatio-temporal structure of the information embedded in the optical signal. This means that the operation of dSiPMs can be fully understood only in statistical terms, but also opens up novel possibilities for extracting information from the measured data. So far, the main driver behind the development of dSiPMs has been the detection of scintillation pulses in detectors for time-of-flight (TOF) positron emission tomography (PET). Several types of dSiPM have been developed in recent years. Moreover, first imaging devices based on dSiPMs have been realized by various groups. This review summarizes the main dSiPM concepts and technologies currently under development, provides an overview of the results obtained recently with dSiPMs-based PET and SPECT devices, and presents a critical outlook on the challenges and chances for dSiPMs in future radiomolecular imaging systems.