As low-field MRI technology is being disseminated into clinical settings, it is important to assess the image quality required to properly diagnose and treat a given disease. In this post-hoc analysis of an ongoing randomized clinical trial, we assessed the diagnostic utility of reduced-quality and deep learning enhanced images for hydrocephalus treatment planning. Images were degraded in terms of resolution, noise, and contrast between brain and CSF and enhanced using deep learning algorithms. Both degraded and enhanced images were presented to three experienced pediatric neurosurgeons accustomed to working in LMIC for assessment of clinical utility in treatment planning for hydrocephalus. Results indicate that image resolution and contrast-to-noise ratio between brain and CSF predict the likelihood of a useful image for hydrocephalus treatment planning. For images with 128x128 resolution, a contrast-to-noise ratio of 2.5 has a high probability of being useful (91%, 95% CI 73% to 96%; P=2e-16). Deep learning enhancement of a 128x128 image with very low contrast-to-noise (1.5) and low probability of being useful (23%, 95% CI 14% to 36%; P=2e-16) increases CNR improving the apparent likelihood of being useful, but carries substantial risk of structural errors leading to misleading clinical interpretation (CNR after enhancement = 5; risk of misleading results = 21%, 95% CI 3% to 32%; P=7e-11). Lower quality images not customarily considered acceptable by clinicians can be useful in planning hydrocephalus treatment. We find substantial risk of misleading structural errors when using deep learning enhancement of low quality images. These findings advocate for new standards in assessing acceptable image quality for clinical use.