Automated Quality Evaluation Index for Arterial Spin Labeling Derived Cerebral Blood Flow Maps

Background Arterial spin labeling (ASL) derived cerebral blood flow (CBF) maps are prone to artifacts and noise that can degrade image quality. Purpose To develop an automated and objective quality evaluation index (QEI) for ASL CBF maps. Study Type Retrospective. Population Data from N = 221 adults, including patients with Alzheimer's disease (AD), Parkinson's disease, and traumatic brain injury. Field Strength/Sequence Pulsed or pseudocontinuous ASL acquired at 3 T using non‐background suppressed 2D gradient‐echo echoplanar imaging or background suppressed 3D spiral spin‐echo readouts. Assessment The QEI was developed using N = 101 2D CBF maps rated as unacceptable, poor, average, or excellent by two neuroradiologists and validated by 1) leave‐one‐out cross validation, 2) assessing if CBF reproducibility in N = 53 cognitively normal adults correlates inversely with QEI, 3) if iterative discarding of low QEI data improves the Cohen's d effect size for CBF differences between preclinical AD (N = 27) and controls (N = 53), 4) comparing the QEI with manual ratings for N = 50 3D CBF maps, and 5) comparing the QEI with another automated quality metric. Statistical Tests Inter‐rater reliability and manual vs. automated QEI were quantified using Pearson's correlation. P < 0.05 was considered significant. Results The correlation between QEI and manual ratings ( R = 0.83, CI: 0.76–0.88) was similar ( P = 0.56) to inter‐rater correlation ( R = 0.81, CI: 0.73–0.87) for the 2D data. CBF reproducibility correlated negatively ( R = −0.74, CI: −0.84 to −0.59) with QEI. The effect size comparing patients and controls improved ( R = 0.72, CI: 0.59–0.82) as low QEI data was discarded iteratively. The correlation between QEI and manual ratings ( R = 0.86, CI: 0.77–0.92) of 3D ASL was similar ( P = 0.09) to inter‐rater correlation ( R = 0.78, CI: 0.64–0.87). The QEI correlated ( R = 0.87, CI: 0.77–0.92) significantly better with manual ratings than did an existing approach ( R = 0.54, CI: 0.30–0.72). Data Conclusion Automated QEI performed similarly to manual ratings and can provide scalable ASL quality control. Evidence Level 2 Technical Efficacy Stage 1