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Current background suppression (BS) methods focus on suppressing tissue signal. The present work aims to test the hypothesis that BS schemes to suppress CSF signal can produce a greater benefit, given the recent observations that water in CSF has more pulsation as part of the neurofluid circulation. We developed a CSF BS scheme that maximally suppresses residual CSF signal using two inversion pulses. Its performance was compared with regular BS and enhanced BS, both of which primarily suppress gray and white matter signals. All schemes were evaluated in single\u2010delay and multi\u2010delay pseudo\u2010continuous ASL (pCASL) MRI. The single\u2010delay scans assessed cerebral blood flow (CBF), while the multi\u2010delay scans measured both CBF and arterial transit time (ATT). Reproducibility was assessed using voxel\u2010wise coefficient of variation (CoV) and spatial Spearman correlation coefficients (Rs). When using the CSF BS scheme, CSF signals were suppressed to less than 1% of the equilibrium magnetization, with gray and white matter signals around 5% in opposite magnetization signs. Complex control\/label subtraction effectively accounted for magnetization signs and obtained the correct difference signal. In single\u2010delay pCASL, CSF BS reduced visually apparent hyper\u2010 and hypo\u2010intensity signals in CBF maps, which were present in the tissue\u2010focused regular and enhanced BS schemes. These artifactual signal fluctuations were particularly pronounced in the brain\u2010stem regions where CSF pulsation was the most severe, but also spread along the z\u2010encoding direction. Quantitatively, CSF BS resulted in a lower voxel\u2010wise CoV (8.8%) and higher R\n                    <jats:sub>s<\/jats:sub>\n                    (0.89) in the CBF maps, compared with tissue\u2010focused BS (CoV 18.8%, R\n                    <jats:sub>s<\/jats:sub>\n                    0.64). In multi\u2010delay pCASL, CSF BS yielded a CoV of 5.9% and 11.3% for CBF and ATT maps, respectively, outperforming both enhanced and regular BS. These results demonstrate that CSF BS can reduce spurious signals and improve image quality in ASL perfusion MRI.\n                  <\/jats:p>","DOI":"10.1002\/nbm.70191","type":"journal-article","created":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T16:29:59Z","timestamp":1764433799000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A CSF Background Suppression Scheme in Arterial Spin Labeling MRI"],"prefix":"10.1002","volume":"39","author":[{"given":"Zhiyi","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, School of Medicine Johns Hopkins University  Baltimore Maryland USA"},{"name":"The Russell H. Morgan Department of Radiology &amp; Radiological Science, School of Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5312-4889","authenticated-orcid":false,"given":"Wen","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, School of Medicine Johns Hopkins University  Baltimore Maryland USA"},{"name":"The Russell H. Morgan Department of Radiology &amp; Radiological Science, School of Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifan","family":"Gou","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, School of Medicine Johns Hopkins University  Baltimore Maryland USA"},{"name":"The Russell H. Morgan Department of Radiology &amp; Radiological Science, School of Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, School of Medicine Johns Hopkins University  Baltimore Maryland USA"},{"name":"The Russell H. Morgan Department of Radiology &amp; Radiological Science, School of Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek\u00a0S.","family":"Yedavalli","sequence":"additional","affiliation":[{"name":"The Russell H. Morgan Department of Radiology &amp; Radiological Science, School of Medicine Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doris\u00a0D.","family":"Lin","sequence":"additional","affiliation":[{"name":"The Russell H. 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Kirby Research Center for Functional Brain Imaging Kennedy Krieger Research Institute  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.29572"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.25197"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2013.06.017"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.31.3.680"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.589234"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2282020409"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A0903"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010014\u20103352\u20101"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2019.101939"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/WAD.0b013e3181b4f736"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.25938"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2016.11.023"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.1910180202"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/1522\u20102594(200007)44:1<92::aid\u2010mrm14>3.0.co;2\u2010m"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2012.10.087"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10334\u2010011\u20100286\u20103"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.20580"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2020.117246"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.29740"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2025.121095"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2022.119464"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41593\u2010025\u201002073\u20103"},{"key":"e_1_2_12_24_1","unstructured":"Z.Hu D.Jiang Y.Cao H.Fan W.Shi andH.Lu \u201cMonitoring Pulsatile CSF Motion in the Subarachnoid Space Using MRI \u201d inProceedings of the 33rd Annual Meeting of ISMRM Singapore (2024) p. 1186."},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/1971400920977031"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.1163"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.29995"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.20356"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.29829"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.20178"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.30091"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.23103"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.1910400308"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2017.12.095"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jcbfm.9600462"},{"key":"e_1_2_12_36_1","unstructured":"Z.Dong \u201c4D CSF Flowmetry to Map Brain\u2010Wide Slow CSF Flow Dynamics and Patterns in Subarachnoid Space \u201d inProceeding of the 32nd Annual Meeting of ISMRM Toronto Canada (2023) p. 3480."},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2009.07.068"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.22345"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.24175"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2015.03.043"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.25834"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ynirp.2021.100063"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2020.07.010"},{"key":"e_1_2_12_44_1","unstructured":"W.Dai P. 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