This study aims to explore the value of IDEAL-IQ combined with IVIM quantitative parameters in assessing the risk stratification of B-ALL children and predicting their early response to chemotherapy. Methods: Eighty-four B-ALL children were categorized into 5 low-risk, 61 medium-risk, and 18 high-risk cases based on WHO risk classification. Among them, 79 children underwent chemotherapy and received lumbar IDEAL-IQ and IVIM scans before chemotherapy and on day 36 of induction chemotherapy. According to day 33 bone marrow MRD after chemotherapy, the children were divided into a CR group (54 cases) and an N-CR group (25 cases). Clinical data such as age, gender, risk stratification, peripheral blood WBC, bone marrow blast percentage, LDH, and CNSL involvement were also collected. Results: Risk stratification: The lumbar vertebral f value in the high-risk group was significantly higher than in the medium-low risk group (P<0.001). Logistic regression analysis with peripheral blood WBC and lumbar vertebral f value as independent variables and clinical risk as the dependent variable revealed that f value is a high-risk factor for B-ALL (ORf=48082.101, P=0.000). Early chemotherapeutic response: Compared to the N-CR group, the CR group had significantly higher PDFF and R2* after chemotherapy (P=0.005 and P=0.008). Pretreatment risk stratification, D, and D* values differed significantly between the CR and N-CR groups (P<0.001, P=0.024, and P=0.03). Post-chemotherapy PDFF, pre-chemotherapy D and D* values were independent risk factors for N-CR. The pre-chemotherapy D+D* value showed a slightly higher AUC (0.817) for predicting N-CR than post-chemotherapy PDFF (AUC=0.807). Conclusion: The lumbar vertebral f value can predict B-ALL clinical risk stratification. Pre-chemotherapy D+D* values are significantly predictive of early chemotherapeutic responses.