Here, we describe a novel polymer platform suitable for efficient diagnostics and potential theranostics based on 89Zr-labeled N-(2-hydroxypropyl)methacrylamide (HPMA)-based copolymer conjugates. The set of polymers differing in molecular weight with either low dispersity or high dispersity were designed, synthesized and their biodistribution in vivo was successfully and precisely observed over 72 h. Moreover, feasibility of two imaging techniques, fluorescence imaging (FI) and positron emission tomography (PET), was compared using labeled polymer conjugates. Both methods gave comparable results thus showing the enhanced diagnostic potential of prepared polymer-dye or polymer-chelator-89Zr constructs. The in vivo and ex vivo PET/FI studies indicated that dispersity and molecular weight of the linear HPMA polymers have a significant influence on the pharmacokinetics of the polymer conjugates. Higher molecular weight and narrower distribution of molecular weights of polymer carriers improves their pharmacokinetic profile for highly prolonged blood circulation and enhanced tumor uptake. Moreover, the same polymer carrier with anticancer drug doxorubicin bound by pH-sensitive hydrazone bond showed higher cytotoxicity and cellular uptake in vitro. Therefore, the HPMA copolymers with low dispersity and molecular weight near the limit of renal filtration can be used as highly efficient polymer carriers of tumor-targeted therapeutics or theranostics with minimal side effects.