Cerebral venography using fluid-suppressed STARFIRE.

Fluid-suppressed STARFIRE (Signal Targeting Alternative Radiofrequency and Flow-Independent Relaxation Enhancement) is a noncontrast method for flow-independent MR venography (MRV). It uses magnitude subtraction of two inversion recovery-prepared segmented three-dimensional (3D) balanced steady-state free precession acquisitions to obtain isotropic cerebral venograms in which both fat and cerebrospinal fluid signals are suppressed. Unlike two-dimensional time-of-flight (2D TOF) MRV, it is insensitive to the flow velocity of the cerebral veins. The method provided excellent depiction of the dural venous sinuses and cortical veins on maximum intensity projection images. Fluid-suppressed STARFIRE and 2D TOF were compared with contrast-enhanced 3D MRV as the reference standard in seven healthy subjects at 1.5 Tesla. Fluid-suppressed STARFIRE compared favorably to 2D TOF on both quantitative and qualitative analyses. Contrast-enhanced MRV provided the highest vein-background relative contrast and best demonstrated the straight sinus, whereas STARFIRE depicted the most venous branches. Further investigation will be required to determine the accuracy for cerebral venous thrombosis.