Hidden risks of service state of urban lifeline infrastructures under the complex environment or load are public safety information that must always be available. The point-measuring sensors commonly used now can only conduct observation of a certain parameter at a certain location, which restricts the ability to diagnosis hidden risks of infrastructures. With the digital twin (DT) model as the carrier and the structural effects as the essential element of series connections, low-cost point monitoring and new high-cost area detection (such as radar or images) data will expect to be efficiently integrated. This paper reviews the development and status of studies on structural monitoring, evaluation, and diagnosis. Three issues for addressing difficulties regarding the predictive diagnosis of structural hidden risks are summarized. Corresponding countermeasures and perspectives on the solution steps are given for the three bottleneck issues. After these processes are performed, theories and technologies system of integrated structural state-effect DT modeling and predictive diagnosis of hidden risks for the urban lifeline infrastructure can be constructed. Then, monitoring and detection data can be converted into structural diagnostic indicators, which will provide an effective implementation paradigm for the predictive diagnosis of hidden risks in lifeline infrastructures. The proposed perspectives can provide useful references for related research.