We report the SPECT, CT and CW Doppler findings in a series of 117 patients with cerebral ischemic lesions and correlate them with the clinical findings. SPECT-PAO proved to be more sensitive in localizing focal lesions than CT, which in 50% of the cases was normal or yielded an image of cerebral atrophy. In the latter cases CW Doppler ultrasound on the supraaortic trunks showed changes, circumscribed or diffuse. On the CW Doppler and SPECT evidence we consider that the CT image of cerebral atrophy may denote an alteration of the cerebral blood flow and metabolism and should be assessed in this light in the diagnosis and prognosis of cerebral ischemic lesions.