Background: Newly invented arterial spin labelling (ASL) is an MR perfusion approach that does not need gadolinium contrast injection or radiation exposure, but instead uses radiofrequency pulses to create magnetically labelled blood protons as an endogenous tracer to measure tissue perfusion. However, it is now extensively employed for acute and chronic cerebrovascular disorders, dementia, epilepsy and neuro oncological objectives in the various perfusion modalities and in functional MRI (fMRI) based on perfusion. There were 121 patients admitted to Alexandria University hospitals between August 2019 and August 2021 with various types of cerebral abnormalities; all of these cases were examined by ASL perfusion after the initial conventional MRI examinations, which sometimes included advanced modalities such as MR spectroscopy (MRS) and Dynamic susceptibility contrast perfusion Study participants ranged in age from one year old to 93 years old, with a mean age of 33.88 +/-25.03. Of them, 72 (59.5%) were men and 49 (40.5%) were females. Nine out of 23 (91.3 percent) of the cases with acute infracted cases showed a diffusion perfusion mismatch with a subsequent ischemic penumbra, but only 11/23 (478.8 percent) showed no diffusion perfusion mismatch. 39 of the study's cases were diagnosed as ischemic insults using conventional MRI, and 23 were acute infarcts. There were 3/23 examples with delayed ASL labelling, and all of them demonstrated an improvement in perfusion on the delayed phases. There were 19 instances in the research where hypo perfused zones had no MRI abnormalities that indicated an epileptic focal. Fifty-five of the study's cases (45.5 percent) were found to be space-occupying lesions, and 22 of those instances had their histopathology examined. Chi-Square tests also show that ASL perfusion may identify the grade of cerebral malignancy, with a P value of 0.0010. 12 Since it does not employ contrast medium, it may be used to evaluate ischemia cases, characterise lesions that take up space in the brain, identify epileptogenic foci and evaluate other abnormalities of the brain.