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Background: The objective of the current meta.analysis was to assess the arterial spin labeling. (ASL) perfusion imaging measurement of cerebral blood flow. (CBF) in patients with brain tumors, and assessing preoperative tumor grade in brain. Materials and Methods: PubMed, Web of Science, Embase, China BioMedicine (CBM), CINAHL, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were chosen to evaluate the associations between ASL and brain cancer. Two reviewers separately evaluated the quality of the included trials. Standardized mean difference (SMD) at 95% confidence interval (95% CI) was also calculated. Results: Finally, 475 patients were enrolled into this meta-analysis from 12 eligible studies and were selected for statistical analysis. Results showed that relative tumor blood flow (rTBF) and relative cerebral blood flow (rCBF) in high-grade brain cancer patients were faster than those in low-grade brain cancer patients. Subgroup analysis stratified by country implied that ASL may be the main prediction of increased rTBF in high-grade brain cancer patients among USA, Korea and China; and rCBF was faster in high-grade brain cancer using ASL in USA and China. Further reference by tissue-stratified analysis revealed a positive association of rTBF with high-grade brain cancer by utilization of ASL in all the experimental subgroups, while rCBF was only correlated in white subgroups. Conclusion: These results showed that rTBF and rCBF were faster in high-grade brain cancer patients, suggesting that ASL may provide suitable measurement for the differential diagnosis of tumor grade in brain. [ABSTRACT FROM AUTHOR]