High-grade astrocytoma represents the most common primary malignant brain tumour in the adult, and is associated with high morbidity and mortality rates. The aim of this study was to investigate the prognostic value of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) in predicting neurological function and tumour therapy response after surgical resection of astrocytoma. The correlation between 99Tcm-HMPAO studies and other noninvasive methods [computed tomography (CT), magnetic resonance imaging (MRI) and 201Tl (SPECT)] was evaluated. The clinical population included 21 patients with previous surgical debulking of astrocytoma. All patients were evaluated with 99Tcm-HMPAO brain SPECT. Seven patients, who suffered progressive clinical deterioration after radiotherapy, underwent dual-isotope SPECT imaging with 201Tl and 99Tcm-HMPAO. Neurological examinations and CT were performed in all patients. Magnetic resonance imaging was performed in seven patients. Prior to radiotherapy and/or chemotherapy, the patients with neurological improvement during the follow-up evaluation commonly showed less intense abnormal 99Tcm-HMPAO uptake than the patients without neurological improvement. In addition, after therapy none of the former patients had increased 99Tcm-HMPAO uptake. Most patients without neurological improvement had evidence of high focal uptake. Computed tomography and MRI usually demonstrated pathological contrast enhancement regardless of the presence or absence of improvement of neurological function. Foci of high 201Tl accumulation were observed on SPECT images in five patients. In four of these patients, the 99Tcm-HMPAO was greater than in normal brain, and in two patients the 99Tcm-HMPAO uptake was lower than in normal brain. One patient with decreased 99Tcm-HMPAO uptake in a medium-sized lesion had a normal 201Tl study. Our hypothesis that 99Tcm-HMPAO SPECT may be useful for providing prognostic information after surgical debulking of astrocytoma seems to be promising. Further studies are needed to document this new important role of 99Tcm-HMPAO SPECT.