Objective To explore the predictive value of magnetic resonance perfusion weighted imaging (MR-PWI) for the progression of transient ischemic attack (TIA) patients to acute cerebral infarction (ACI). Methods This study included 64 patients with TIA caused by carotid artery stenosis who were admitted to Luoyang Yiluo Hospital from September 2022 to February 2024. All patients underwent digital subtraction angiography (DSA) for cerebral vascular examination and MR-PWI examinations, and received basic treatments such as controlling blood pressure and lowering blood sugar. Then, they were treated with clopidogrel bisulfate tablets for 3 months, and were followed up for 3 months after the treatment. The disease progression of the patients was analyzed, and the magnetic resonance cerebral perfusion parameters of the occurrence group and the non-occurrence group were compared. The receiver operator characteristic (ROC) curve was used to analyze its predictive value. Results During the follow-up period, 12 patients developed ACI, with an incidence rate of 18.75%. The relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) in the occurrence group were lower than those in the non-occurrence group (t = 4.759, 4.707, both P < 0.05), while there were no statistically significant differences in relative mean transit time (rMTT) and time to peak (TTP) (t = 0.878, 0.812, both P > 0.05); ROC curve analysis showed that the area under the curve (AUC) of rCBV for predicting ACI was 0.789, with a sensitivity, specificity, and accuracy of 80.25%, 72.00%, and 76.33%, respectively; the AUC of rCBF was 0.842, with a sensitivity, specificity, and accuracy of 64.10%, 100%, and 73.50%. Conclusion When TIA patients progress to ACI, the magnetic resonance cerebral perfusion parameters will change. rCBV and rCBF can be used to predict the progression of TIA patients to ACI and have certain clinical value.