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Both numerical simulations and in vivo experiments were performed to investigate the confounding factors of cardiac\u2010induced variations of labeling efficiency and arterial transit time on pCASL signal fluctuations. An in vivo experiment was conducted to examine and optimize the postlabeling delay in FPR\u2010pCASL. A test\u2013retest study and a cross\u2010validation study were performed to evaluate the reproducibility and reliability of FPR\u2010pCASL for microvascular pulsatility index (PI) measurements. An aging study was conducted to investigate the effect of aging on cerebral microvascular PI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Numerical simulation showed that cardiac\u2010induced variations in labeling efficiency and arterial transit time contributed to, at most, 3% and 2% of the pCASL signal fluctuations, respectively, which is nearly an order of magnitude smaller than the measured PI. A good test\u2013retest reproducibility in microvascular PI (intraclass correlation coefficient\u2009=\u20090.86, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) and strong correlations with macrovascular PIs by phase\u2010contrast MRI (<jats:italic>r<\/jats:italic>\u2009=\u20090.72, 0.63, 0.71, and 0.74 for internal carotid artery, vertebral artery, middle cerebral artery M2\/3, and M4, respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) were obtained. The elderly adults showed higher microvascular PI values than younger adults (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This work has demonstrated the feasibility and reliability of the FPR\u2010pCASL technique for directly assessing cerebral microvascular pulsatility.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mrm.70004","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T08:48:37Z","timestamp":1753174117000},"page":"2435-2446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessing cerebral microvascular pulsatility using flow pulsatile\u2010resolved pseudo\u2010continuous arterial spin labeling <scp>MRI<\/scp>"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0889-5629","authenticated-orcid":false,"given":"Tianrui","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine Northwestern University   Chicago Illinois USA"},{"name":"Department of Biomedical Engineering Northwestern University  Evanston Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianing","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine Northwestern University   Chicago Illinois USA"},{"name":"Department of Biomedical Engineering Northwestern University  Evanston Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yining","family":"He","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine Northwestern University   Chicago Illinois USA"},{"name":"Department of Biomedical Engineering Northwestern University  Evanston Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan Pruneau","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Tereza","family":"Gamez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine Northwestern University   Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5173-7059","authenticated-orcid":false,"given":"Lirong","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Feinberg School of Medicine Northwestern University   Chicago Illinois USA"},{"name":"Department of Biomedical Engineering Northwestern University  Evanston 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