Reconstruction-based methods, particularly those leveraging autoencoders, have been widely adopted to perform anomaly detection in brain MRI. While most existing works try to improve detection accuracy by proposing new model structures or algorithms, we tackle the problem through image quality assessment, an underexplored perspective in the field. We propose a fusion quality loss function that combines Structural Similarity Index Measure loss with l1 loss, offering a more comprehensive evaluation of reconstruction quality. Additionally, we introduce a data pre-processing strategy that enhances the average intensity ratio (AIR) between normal and abnormal regions, further improving the distinction of anomalies. By fusing the aforementioned two methods, we devise the image quality assessment (IQA) approach. The proposed IQA approach achieves significant improvements (>10%) in terms of Dice coefficient (DICE) and Area Under the Precision-Recall Curve (AUPRC) on the BraTS21 (T2, FLAIR) and MSULB datasets when compared with state-of-the-art methods. These results highlight the importance of invoking the comprehensive image quality assessment in medical anomaly detection and provide a new perspective for future research in this field.
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