Purpose: To address two problems for perfusion studies in the middle or inferior brain regions: (1) to reduce venous artifacts due to the intrinsic superior labeling of FAIR; (2) to alleviate the discrepancy of the existence of both superior and inferior boluses, but with only the inferior bolus having a temporally defined bolus width with Q2TIPs or QUIPSS.Materials and Methods: Superior tagging suppression methods for FAIR with different combinations of pre-and postinversion superior saturation pulses were evaluated and compared with FAIR with Q2TIPS for producing perfusion maps of superior, middle, and inferior brain regions.Results: One preinversion plus two postinversion superior saturation radio frequency pulses effectively suppressed the superior tagging of FAIR and sufficiently eliminated venous artifacts without negative effects, avoiding the overestimations of cerebral blood flow that can occur in FAIR.Conclusion: FAIR ASST improves FAIR with Q2TIPS and provides more reliable and accurate blood flow estimations for perfusion studies of middle and lower brain regions. FAIR ASST confers the advantages of asymmetric PASL techniques, such as PICORE, in which only the inferiorly labeled blood is used for perfusion quantification, to the symmetric PASL technique FAIR, while preserving the robustness of FAIR against MT effects. THERE ARE TWO major types of pulsed arterial spin labeling (PASL) techniques: symmetric (1-4) and asymmetric (5-7). Symmetric PASL techniques are mainly based on the flow-sensitive alternating inversion recovery (FAIR) technique (3,(8)(9)(10)(11); the symmetric application of inversion pulses relative to the center of the imaging section makes symmetric PASL techniques very robust against magnetization transfer (MT) effects. Cerebral blood flow (CBF) quantification can be achieved by using FAIR with QUIPSS (12) or Q2TIPS (13) and a single blood compartment model (14,15). In FAIR with Q2TIPS, temporal bolus width is defined by performing inferior saturations to null the tail of the labeled blood bolus.However, when performing perfusion studies in regions other than the superior part of the brain, the superior inversion band of FAIR can also label blood, which results in confounds or discrepancies between the actual boluses and the fact that only the inferior bolus is considered by Q2TIPS or QUIPSS in temporal bolus width definition for perfusion quantification using the single-subtraction blood flow quantification method (12,13). First, if there is a contribution of superiorly labeled arterial blood to tissue perfusion, the corresponding temporal bolus width should also be defined by performing superior saturations. A second confound occurs if the superiorly labeled blood contains venous blood; superior labeled venous blood can generate adverse frequency or phase errors and create severe artifacts in specific regions, such as the cerebellum, making blood flow measurements there unreliable. These difficulties also exist when using traditional FAIR-based techniques for perfusion studies of...