Clinical practice guidance for imaging selection in pulsatile tinnitus: an evidence-based expert consensus

Pulsatile tinnitus (PT) is a rhythmic sound synchronized with the patient's heartbeat that represents a complex diagnostic challenge with a broad spectrum of vascular and non-vascular etiologies. Persistent symptoms can severely impact mental health, yet a specific causative abnormality can be identified via targeted radiological imaging in more than 75% of cases. Improper imaging selection frequently leads to misdiagnosis, reduced therapeutic efficacy, and increased healthcare costs. The choice of imaging protocol must be guided by a thorough initial clinical evaluation, including detailed medical history, physical maneuvers, and otoscopic examinations. Commissioned by the Medical Imaging Center Branch of the Chinese Hospital Association, this evidence-based expert consensus guidance aims to provide structured recommendations for the strategic selection of imaging modalities in PT patients. The guidance explicitly distinguishes recommendations grounded in comparative diagnostic literature from those derived from formal expert consensus where high-level comparative evidence is limited.