Clinical utility of Arterial Spin Labeling perfusion images in pediatric neurological emergencies

Cerebral perfusion abnormalities often represent an early and dynamic marker in pediatric neurological emergencies, preceding structural changes detectable by conventional MRI. Arterial Spin Labeling (ASL), a noninvasive and contrast-free perfusion MRI technique, allows for quantitative assessment of cerebral blood flow and is gaining relevance in acute neuroimaging protocols. This review discusses the diagnostic and prognostic utility of ASL across a range of acute conditions including ischemic stroke, encephalopathies, and seizures. Technical principles, typical perfusion patterns, and clinical implications are outlined, highlighting ASL's potential to improve diagnostic confidence and optimize care in pediatric emergency neuroradiology.