CT arteriography and venography in pulsatile tinnitus: preliminary results

Abstract

Background and purpose: Pulsatile tinnitus (PT), a common disorder, can be caused by a variety of otologic and vascular lesions. Various imaging modalities, including CT, MR imaging and angiography, and conventional angiography, have been used in the assessment of PT. Ideally, a single imaging study to evaluate for the largest variety of etiologies would be optimal. In our study, we examine the potential for CT arteriography and venography (CTA/V) in the evaluation of PT.

Methods: Sixteen patients with PT were prospectively evaluated by an otolaryngologist, had a normal otologic examination, and were referred for a CTA/V. All examinations were performed on a 16-section multidetector CT. The carotid bifurcations, internal carotid artery course, transverse and sigmoid sinuses, jugular foramen, internal jugular vein, sella turcica, and temporal bones were evaluated.

Results: Seven of the 16 patients had lesions on CTA/V that could account for their PT. Examples of pathologic conditions in the series included a significantly dominant venous system, a venous diverticulum with stricture, and a transverse sinus stenosis.

Conclusions: Preliminary findings indicate that CTA/V can be a valuable imaging tool in the assessment of PT. With this technique, arterial, venous, middle, and inner ear causes of PT can be excluded.

Fig 1.

Dominant left venous sinus system in a 27-year-old woman with left-sided pulsatile tinnitus. A, Coronal image at intermediate window demonstrates a dominant left sigmoid sinus (arrows). B, Note the markedly dominant left jugular vein on this axial image at the jugular foramen level.

Fig 2.

Venous diverticulum in a 69-year-old man with long-standing right-sided pulsatile tinnitus. A, Axial image demonstrates a right distal transverse sinus venous diverticulum extending through a dehiscent sigmoid plate into the mastoid complex (arrow). B, Axial image, same level, wider windows for bone detail confirms the osseous defect and the diverticulum (arrow).

Fig 3.

Transverse sinus stenosis in a 34-year-old woman with right-sided pulsatile tinnitus. A, Axial image in a vascular window demonstrating a distal right transverse sinus stenosis (arrows). B, Coronal image in a vascular window in the same patient demonstrating a distal right transverse sinus stenosis (arrows).