Neuroimaging can now reveal an extraordinary amount of informa-tion about the structural, functional and biochemical characteristics of the human brain. Further under-standing the biological processes underlying brain dysfunction, and how these adapt to treatment, is clearly of significance to research-ers involved in medical trials. But how clinically meaningful is this information? A critical evaluation from conceptual and empirical per-spectives was the goal of the first 'Neuroimaging as Endpoints in Clinical Trials' provence workshop, run from 2 June to 5 June 2010 in the charming village of Sernhac, France. Several thought-provoking, interlinked and recurring themes emerged and are enumerated here to further advance a fast developing field.