PURPOSE:To investigate the correlation between 3D arterial spin labeling(3D-ASL),tumor blood flow(TBF)and histopathological features of tongue masses.METHODS:A prospective analysis was performed in 55 patients with clinically probable tongue masses in Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from December 2019 to December 2021,and all of them underwent conventional maxillofacial MRI scanning,3D-ASL,diffusion-weighted imaging(DWI)and dynamic contrast-enhanced(DCE)sequence scanning before surgery.TBF of lesions was calculated,and postoperative tissue sections were stained with CD34 and Ki67 to assess microvessel density(MVD).Mann-Whitney U test was used to compare and analyze TBF between different diseases,as well as the correlation between TBF and MVD with SPSS 26.0 software package.RESULTS:Ectopic thyroid(ET)showed an overall red hyperperfusion area(100%)on the TBF pseudocolor map of ASL,and the hyperperfusion area was the largest(100%).The proportion of hyperperfusion in early squamous cell carcinoma(SCC)was high(13 cases,13/15,86.7%).The difference between TBFmax,TBFmean,and ADC values in the largest region of tumor blood flow was statistically significant(P<0.05).MVD was strongly positively correlated with TBFmean and TBFmax in all tumors(rs=0.89,0.93,R2=0.70,0.84,P<0.01).CONCLUSIONS:3D-ASL can noninvasively assess tongue tumor blood flow and help distinguish benign and malignant tumors.The higher the SCC grade,the less hyperperfusion occurs,which reflects the degree of tumor invasion.