To evaluate the relationship between temporal hypoperfusion in the acute phase of patients with eating disorders and the long-term clinical outcome. Brain perfusion was studied using Tc-99m HMPAO SPECT in 17 patients with eating disorders (ED) and compared with 12 controls (C). Semiquantitative analysis was carried out by left/right indexes. Clinical records were reviewed 15 years later and the patients were classified into 2 groups: bad outcome in 10 patients and good outcome in 4. The results of the basal SPECT were compared with the clinical outcome. The mean of the differences of temporal perfusion in the lower slice was 0.1476 +/- 0.1121 in ED and 0.03 +/- 0.019 in C (P < 0.001). Comparisons between C and bad outcome showed a significant difference (P < 0.01). There was no significant difference between good outcome and C. The temporal hypoperfusion in the acute phase of patients with ED showed a correlation with the long-term clinical outcome and suggested a prognostic value of temporal hypoperfusion.