Background: Perfusion magnetic resonance imaging (MRI) is an advanced neuroimaging technique that provides critical information about cerebral hemodynamics, including cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT).

Aim: This literature review aims to evaluate the clinical impact, diagnostic utility, and current applications of perfusion MRI in paediatric neuroimaging, with a focus on its role in neurological disorders, treatment planning, and outcome assessment.

Methods: A narrative literature review was conducted by analyzing peer-reviewed articles, clinical studies, and recent advances in perfusion MRI techniques in paediatric populations. Relevant studies focusing on arterial spin labeling (ASL), dynamic susceptibility contrast (DSC), and dynamic contrast-enhanced (DCE) perfusion techniques were included.

Results: Perfusion MRI has demonstrated significant value in the diagnosis and management of paediatric brain tumours, epilepsy, stroke, hypoxic-ischemic injury, and vascular malformations. Techniques such as ASL provide non-contrast imaging alternatives, making them especially suitable for children. Perfusion imaging improves lesion characterization, aids in grading tumours, and helps differentiate between tumour recurrence and treatment-related changes.

Conclusion: Perfusion MRI is a powerful and evolving tool in paediatric neuroimaging, offering both functional and physiological insights that complement conventional MRI. Its growing clinical applications highlight its importance in improving diagnostic accuracy and guiding therapeutic decisions in paediatric neurological disorders.

Keywords: Perfusion MRI, Paediatric Neuroimaging, Cerebral Blood Flow, Arterial Spin Labeling