Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up

PURPOSE OF REVIEW: Identification of the underlying cause of pulsatile tinnitus is important for treatment decision making and for prognosis estimation. For this, an adequate diagnostic imaging strategy is crucial. RECENT FINDINGS: Both CT and MRI can be useful, and in general, these modalities provide complementary diagnostic information. The scanning protocol can be optimized based on the estimated a priori chance for finding specific pathology, or the need to rule out more rare but clinical significant disease. In recent years, dynamic CTA, also referred to as 4D-CTA, has become available as a new technique that enables non-invasive evaluation of hemodynamics for the detection, classification, and follow-up of vascular malformations. SUMMARY: The value of different diagnostic imaging modalities in the work-up of pulsatile tinnitus is discussed in relation to the differential diagnosis. Furthermore, imaging findings of different diseases are presented, both for CT and MRI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40134-017-0199-7) contains supplementary material, which is available to authorized users.