Some proponents of positron imaging have suggested that single-photon imaging procedures would be totally replaced by PET imaging [1–3]. Proponents and opponents of such a scenario have each argued about the relative merits of the two modalities, and the issues involved in the clinician's choice in different health-care systems [4–7]. These issues include availability of a PET alternative to a planar/SPECT procedure, regulatory approval of the radiopharmaceuticals and procedures, cost/reimbursement issues, and radiation protection for personnel. The growth of PET examinations in recent years has been impressive, although at different rates in different parts of the world. In a country where diffusion of clinical PET started early, such as the USA, the number of PET examinations increased by about 35% in the period 2005–2008, although with a declining computed annual growth rate (CAGR) from 14.5% in 2006 to 4.4% in 2008 (source: IMV, Des Plaines, IL). Where diffusion of clinical PET started more recently, as in Western Europe, the number of PET procedures increased by 82% with a smaller decline in CAGR, from 29% to 21%, over the same period (sources: Medical Options, London, UK; European Association of Nuclear Medicine). Contrary to what one would expect for PET gradually replacing single-photon imaging, this increase in PET has not been mirrored by a corresponding decrease in planar/SPECT examinations. This confirms the overall vitality of functional imaging with nuclear medicine. In fact, the only single-photon procedure that has declined consistently (by 7–8%) is ventilation/perfusion lung scanning for pulmonary embolism, clearly due to competition from multidetector spiral-CT pulmonary angiography [8] and not from PET. The number of all other planar/SPECT procedures has remained stable in Europe or has actually increased, either moderately (+2% for brain and myocardial perfusion), or markedly: +17.4% for infection/inflammation imaging, +17.5% for sentinel node scintigraphy, +42.1% for brain receptor imaging. In this pattern one can see the effects of an ongoing crossfertilization already in place between the two imaging methodologies. Transfer of PET/CT cross-sectional imaging expertise to SPECT/CT has clearly revitalized the latter for both preclinical and clinical applications [9–11]. The advantages include not only improved topographic localization compared with radionuclide-based transmission/emission imaging, but also more accurate attenuation correction making quantitation possible also with SPECT [12]. Therefore, future scenarios for nuclear medicine are taking on new perspectives, especially considering that the shortage of molybdenum-99 [13] seems now to be solved [14]. This change in perspective is reflected by a recent surge in new SPECT/CT installations; in the third quarter of 2010 a major manufacturer has seen revenues from sales of SPECT installations exceed those from PET installations for the first time in years (personal communication), a large proportion of which are multimodality SPECT/CT devices. Likewise, transfer of conventional SPECT studies to PET/CT is being explored with a synergistic flow in the opposite direction with questions such as: "How might we image infection and/or inflammation with PET/CT?" and "What would a high resolution ventilation/perfusion PET/CT lung scan look like?". PET and SPECT are synergistic for introducing new radiopharmaceuticals for both preclinical and clinical G. Mariani (*) Regional Center of Nuclear Medicine, University of Pisa Medical School, Via Roma 67, I-56100 Pisa, Italy e-mail: g.mariani@med.unipi.it