Non-invasive imaging modalities for diagnosing pulsatile tinnitus: a comprehensive review and recommended imaging...

Area of Science:

• Radiology
• Otolaryngology
• Neurology

Background:

• Pulsatile tinnitus (PT) presents diagnostic challenges due to diverse underlying causes.
• Non-invasive imaging is crucial for identifying PT etiologies, avoiding risks of invasive angiography.
• Current diagnostic pathways involve CT, ultrasound, and MRI, with no established primary modality.

Purpose of the Study:

• To review the benefits and limitations of non-invasive imaging modalities for diagnosing PT.
• To highlight characteristic imaging findings for common PT causes.
• To propose a clinical algorithm for guiding PT imaging evaluation.

Main Methods:

• Narrative literature review focusing on non-invasive imaging techniques for PT.
• Discussion of MRI protocols including time-of-flight, MRA, DWI, and ASL.
• Analysis of imaging findings for vascular, neoplastic, and systemic PT causes.

Main Results:

• MRI is emerging as a preferred first-line screening test for PT due to its diagnostic efficacy and safety.
• Specific MRI techniques can identify serious conditions like vascular shunts, venous sinus stenosis, and tumors.
• CT and ultrasound also play roles, but MRI offers comprehensive evaluation.

Conclusions:

• MRI demonstrates significant advantages as a primary screening tool for pulsatile tinnitus.
• A structured imaging approach, guided by an algorithm, can improve diagnostic accuracy for PT.
• Non-invasive imaging is vital for timely and safe identification of PT causes.