Supporting measurements or more averages? How to quantify cerebral blood flow most reliably in 5 minutes by arterial spin labeling

PURPOSE: To determine whether sacrificing part of the scan time of pseudo‐continuous arterial spin labeling (PCASL) for measurement of the labeling efficiency and blood [Formula: see text] is beneficial in terms of CBF quantification reliability. METHODS: In a simulation framework, 5‐minute scan protocols with different scan time divisions between PCASL data acquisition and supporting measurements were evaluated in terms of CBF estimation variability across both noise and ground truth parameter realizations taken from the general population distribution. The entire simulation experiment was repeated for a single‐post‐labeling delay (PLD), multi‐PLD, and free‐lunch time‐encoded (te‐FL) PCASL acquisition strategy. Furthermore, a real data study was designed for preliminary validation. RESULTS: For the considered population statistics, measuring the labeling efficiency and the blood [Formula: see text] proved beneficial in terms of CBF estimation variability for any distribution of the 5‐minute scan time compared to only acquiring ASL data. Compared to single‐PLD PCASL without support measurements as recommended in the consensus statement, a 26%, 33%, and 42% reduction in relative CBF estimation variability was found for optimal combinations of supporting measurements with single‐PLD, free‐lunch, and multi‐PLD PCASL data acquisition, respectively. The benefit of taking the individual variation of blood [Formula: see text] into account was also demonstrated in the real data experiment. CONCLUSIONS: Spending time to measure the labeling efficiency and the blood [Formula: see text] instead of acquiring more averages of the PCASL data proves to be advisable for robust CBF quantification in the general population.