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Phase contrast (PC) magnetic resonance imaging (MRI) is a primary method used to quantify blood flow. Cerebral blood flow (CBF) is an important hemodynamic parameter to characterize cerebrovascular and neurological diseases. However, a critical step in CBF quantification using PC MRI is vessel segmentation, which is largely manual, and thus time-consuming and prone to interrater variability. Here, we present encoder–decoder deep learning models to automate segmentation of neck arteries to accurately quantify CBF. The PC-MRI data were collected from 46 Moyamoya (MM) patients and 107 healthy control (HC) participants. Three segmentation U-Net models (Standard, Nested, and Attention) were compared. The PC MRI images were taken before and 15 min after vasodilation. The models were assessed based on their ability to detect the internal carotid arteries (ICAs), external carotid arteries (ECAs), and vertebral arteries (VAs), using the Dice score coefficient (DSC) of overlap between manual and predicted segmentations and receiver operator characteristic (ROC) metric. Analysis of variance, Wilcoxon rank-sum test, and paired t-test were used for comparisons. The Standard U-NET, Attention U-Net, and Nest U-Net models achieved results of mean DSCs of 0.81 ± 0.21, and 0.85 ± 0.14, and 0.85 ± 0.13, respectively. The ROC curves revealed high area under the curve scores for all methods (≥0.95). While the Nested and Attention U-Net architectures accomplished reliable segmentation performance for HC and MM subsets, Standard U-Net did not perform as well in the subset of MM patients. Blood flow velocities calculated by the models were statistically comparable. In conclusion, optimized deep learning architectures can successfully segment neck arteries in PC MRI images and provide precise quantification of their blood flow.

Cerebrovascular reactivity (CVR) reflects the capacity of the brain to meet changing physiological demands and can predict the risk of cerebrovascular diseases. CVR can be obtained by measuring the change in cerebral blood flow (CBF) during a brain stress test where CBF is altered by a vasodilator such as acetazolamide. Although the gold standard to quantify CBF is PET imaging, the procedure is invasive and inaccessible to most patients. Arterial spin labeling (ASL) is a non-invasive and quantitative MRI method to measure CBF, and a consensus guideline has been published for the clinical application of ASL. Despite single post labeling delay (PLD) pseudo-continuous ASL (PCASL) being the recommended ASL technique for CBF quantification, it is sensitive to variations to the arterial transit time (ATT) and labeling efficiency induced by the vasodilator in CVR studies. Multi-PLD ASL controls for the changes in ATT, and velocity selective ASL is in theory insensitive to both ATT and labeling efficiency. Here we investigate CVR using simultaneous 15O-water PET and ASL MRI data from 19 healthy subjects. CVR and CBF measured by the ASL techniques were compared using PET as the reference technique. The impacts of blood T1 and labeling efficiency on ASL were assessed using individual measurements of hematocrit and flow velocity data of the carotid and vertebral arteries measured using phase-contrast MRI. We found that multi-PLD PCASL is the ASL technique most consistent with PET for CVR quantification (group mean CVR of the whole brain = 42±19% and 40±18% respectively). Single-PLD ASL underestimated the CVR of the whole brain significantly by 15±10% compared with PET (p