Analysis of vascular pulsatile tinnitus using dual-energy CTA+CTV and 4D Flow MRV

LIU Shanfeng; SUN Lixin; WANG Linsheng; HU Na; LIU Congtao; ZHAO Hui; LI Xiaoqin

doi:10.20258/j.cnki.1006-9011.2025.02.005

Abstract：Objective To analyze the imaging manifestations of cranial dual-energy CTA+CTV and 4D Flow MRV in patients with pulsatile tinnitus(PT)and to explore its possible causes.Methods A retrospective analysis was conducted on the imaging data of 451 patients diagnosed with unilateral vascular PT in the tinnitus department of our hospital.Among them,451 patients underwent cranial dual-energy CTA+CTV examination,and 204 patients underwent 4D Flow MRV examination simultaneously.Results 1)Via CTA+CTV test,417 cases(92.46%)showed abnormalities.A total of 373 cases(82.70%)had venous abnor-malities,manifesting as 221 cases(49.00%)of abnormal morphology of the transverse sinus-sigmoid sinus lumen(stenosis,di-lation)combined with sinus plate bone loss,136 cases(30.16%)of sigmoid sinus diverticulum,and 16 cases(3.54%)of high jugular bulb with diverticulum.A total of 44 cases(9.76%)had arterial abnormalities;and 2)By 4D Flow MRV examination,180 cases(88.23%)showed complex blood flow patterns in the transverse sinus-sigmoid sinus,in which 88 cases(43.14%)had high-speed blood flow at the stenotic site of the transverse sinus and turbulence at the downstream transition site of the transverse sinus-sigmoid sinus,16 cases(7.84%)had high-speed blood flow at the stenotic site of the transverse sinus,turbulence at the downstream transition site of the transverse sinus-sigmoid sinus,and diverticulum formation,33 cases(16.18%)had high-speed blood flow only at the stenotic site of the transverse sinus,and 43 cases(21.08%)had turbulence only at the transition site of the transverse sinus-sigmoid sinus.Conclusion Abnormal morphology of the transverse sinus-sigmoid sinus lumen(stenosis,dila-tion)combined with sinus plate bone loss and sigmoid sinus diverticulum are common causes in this group of patients with vascu-lar PT.It is inferred from the streamline diagram of 4D Flow MRV that the turbulence in the downstream transverse sinus-sigmoid sinus transition zone caused by high-speed blood flow at the transverse sinus stenosis may be the common cause of venous PT.