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Background  The Brain Atrophy and Lesion Index ( BALI ), which evaluates several common aging‐related  MRI  changes in combination, has been validated as a feasible method to assess the status of structural brain health. Previous studies have been based primarily on older participants and high‐field  MRI . Here, we tested the generalizability of the  BALI  by examining its measurement properties in a wide age range at both high and conventional  MRI  field strengths.    Methods  Subjects (n = 229) who had T2 WI  at either 1.5T or 3.0T were grouped into younger (age ≤ 60 years) and older (age > 60 years) groups. Image evaluation and scoring were performed independently by two experienced neuroradiologists who have mastered the  BALI  method. Inter‐ and intrarater agreement rates were examined comparing age groups and field strengths.    Results  The intraclass correlation coefficient for the  BALI  total score was consistently high under each experimental condition (interrater  ICC  ≥ 0.92, 95%  CI : 0.84‐0.96), with no statistical difference between age groups (Fisher  Z  = 1.43) or field strengths ( Z  = 0.60). The reliability for  BALI  category subscores ranged between moderate and perfect (eg, 0.85 vs 0.57 for  GA ), similar for both age groups and typically greater at 3.0T than at 1.5T.    Conclusion  The  BALI  based on T2 WI  can be reliably applied to the evaluation of the whole‐brain health of both younger and older adults at both field strengths, even though high‐field  MRI  is preferable.

Reliability of the MRI ‐based Brain Atrophy and Lesion Index in the evaluation of whole‐brain structural health