Currently, idiopathic Parkinson's disease can only be diagnosed definitively by the demonstration of intracellular Lewy body inclusions on histological specimens of brain tissue—an approach that is impractical in living individuals. In this Review, David Brooks discusses recent advances in noninvasive imaging approaches that are providing important insights into the structural, pathophysiological and pharmacological changes associated with Parkinson's disease, and could have major implications for the future diagnosis and management of this condition.