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Neuroimaging
Review
Non-invasive imaging modalities for diagnosing pulsatile tinnitus: a comprehensive review and recommended imaging algorithm
  1. Madhavi Duvvuri1,
  2. Haider Ali2,
  3. Matthew Robert Amans1
  1. 1Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  2. 2Radiology and Neurological Surgery, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Matthew Robert Amans; matthew.amans{at}ucsf.edu

Abstract

Pulsatile tinnitus (PT) is a challenging diagnostic condition arising from various vascular, neoplastic, and systemic disorders. Non-invasive imaging is essential for identifying underlying causes while minimizing risks of invasive diagnostic angiography. Although no consensus exists on the primary imaging modality for PT and currently CT, ultrasound, and MRI are used in the diagnostic pathway, MRI is increasingly preferred as the first-line screening test for its diagnostic efficacy and safety. MRI protocols such as time-of-flight, magnetic resonance angiography, diffusion-weighted imaging, and arterial spin labeling can identify serious causes, including vascular shunting lesions, venous sinus stenosis, and tumors. In this narrative review of the current literature we discuss the benefits and limitations of various non-invasive imaging modalities in identifying the characteristic imaging findings of the most common causes of PT and also provide an algorithm that clinicians can use to guide the imaging evaluation.

  • Angiography
  • Magnetic Resonance Angiography
  • CT
  • MRI
  • Tumor

https://doi.org/10.1136/jnis-2023-020949

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    Footnotes

    • X @mattamansMD

    • Contributors MD wrote the manuscript and supervised the work. HA assisted with the literature review. MRA provided critical feedback and supervised the work. MRA is the guarantor.

    • Funding This study was funded by the National Institute of Biomedical Imaging and Bioengineering (T32EB001631).

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.