One of the main problems regarding the follow up patients withBrain tumors treated radiotherapy is the distinction between radiation necrosis & relapse. In many cases CT & / or MRI are unable todistinguish between the two.We conducted a study on 30 patients with documented supratentorial brain primaries to the center of clinical oncology & nuclearmedicine NEMROCKThese patient were evaluated by anatomical imaging (CT& / or MRI)TC 99m (V) DMSA SPECT .results of anatomical imaging & SPECTwere compared .Furthermore the clinical outcome was correlation with SPECT ratios, & result showed a tight relation that could possiblyrender SPECT a good follow up tool patients with supratentorial brainprimaries.