BACKGROUND Early thrombolytic therapy is crucial to treat acute cerebral infarction, especially since the onset of thrombolytic therapy takes 1-6 h. Therefore, early diagnosis and evaluation of cerebral infarction is important. AIM To investigate the diagnostic value of magnetic resonance multi-delay three-dimensional arterial spin labeling (3DASL) and diffusion kurtosis imaging (DKI) in evaluating the perfusion and infarct area size in patients with acute cerebral ischemia. METHODS Eighty-four patients who experienced acute cerebral ischemia from March 2019 to February 2021 were included. All patients in the acute stage underwent magnetic resonance-based examination, and the data were processed by the system’s own software. The apparent diffusion coefficient (ADC), average diffusion coefficient (MD), axial diffusion (AD), radial diffusion (RD), average kurtosis (MK), radial kurtosis (fairly RK), axial kurtosis (AK), and perfusion parameters post-labeling delays (PLD) in the focal area and its corresponding area were compared. The correlation between the lesion area of cerebral infarction under MK and MD and T2-weighted imaging (T2WI) was analyzed. RESULTS The DKI parameters of focal and control areas in the study subjects were compared. The ADC, MD, AD, and RD values in the lesion area were significantly lower than those in the control area. The MK, RK, and AK values in the lesion area were significantly higher than those in the control area. The MK/MD value in the infarct lesions was used to determine the matching situation. MK/MD < 5 mm was considered matching and MK/MD ≥ 5 mm was considered mismatching. PLD1.5s and PLD2.5s perfusion parameters in the central, peripheral, and control areas of the infarct lesions in MK/MD-matched and -unmatched patients were not significantly different. PLD1.5s and PLD2.5s perfusion parameter values in the central area of the infarct lesions in MK/MD-matched and -unmatched patients were significantly lower than those in peripheral and control areas. The MK and MD maps showed a lesion area of 20.08 ± 5.74 cm 2 and 22.09 ± 5.58 cm 2 , respectively. T2WI showed a lesion area of 19.76 ± 5.02 cm 2 . There were no significant differences in the cerebral infarction lesion areas measured using the three methods. MK, MD, and T2WI showed a good correlation. CONCLUSION DKI parameters showed significant difference between the focal and control areas in patients with acute ischemic cerebral infarction. 3DASL can effectively determine the changes in perfusion levels in the lesion area. There was a high correlation between the area of the infarct lesions diagnosed by DKI and T2WI.