To analyze the correlation between cerebral hemodynamics and white matter lesion (WML) severity in patients with ischemic stroke. Methods: A total of 120 patients with ischemic stroke were enrolled. Color Doppler flow imaging and time-lapse magnetic resonance angiography (TOF-MRA) were performed on all patients. WML were graded according to the Fazekas scale. The peak systolic velocity (PSV), end-diastolic flow rate (EDV), vascular resistance index (RI), distal/proximal signal intensity ratio (SIR) of cerebral middle artery stenosis, global cerebral perfusion (tCBFV), anterior circulation cerebral blood flow (aCBFV), and posterior circulation cerebral blood flow (pCBFV) were compared; the SIR values in patients with moderate or severe stenosis of the middle cerebral artery and WML scores in each region were compared, and the correlation of each indicator was analyzed. Results: There were 95 patients with WML (79.17% ); among these, the number of cases with the lesion in the basal ganglia, frontal lobes, temporal lobe, top occipital lobe, and area under the curtain was 46 (48.42%), 86 (90.53%), 48 (50.53%), 56 (58.95% ), and 3 (3.16% ), respectively. With the increase of WML grade, the internal carotid artery RI, vertebral artery PSV, and vertebral artery RI increased and the internal carotid artery EDV and SIR, tCBFV, and aCBFV decreased (P<0.05). There was a statistically significant difference in the SIR value and WML scores of the frontal, temporal, and occipital lobes between patients with moderate stenosis and severe stenosis (P<0.01). Correlation analysis showed that in WML patients, PSV and RI were positively correlated with lesion grade, SIR and tCBFV were negatively correlated with lesion grade, and SIR was negatively correlated with stenosis degree (P<0.05). Conclusion: The cerebral hemodynamics of patients with acute ischemic stroke has a certain correlation with the severity of WML lesions. Hemodynamic regression and the decrease of cerebral perfusion increase the severity of WML lesions.