title: Value of DSA in the diagnostic workup of pulsatile tinnitus.
abstract: OBJECTIVE
  Pulsatile tinnitus (PT) is a rare complaint, but can be a symptom of life-threatening disease. It is often caused by vascular pathologies, e.g. dural arteriovenous fistula (dAVF), arteriovenous malformation (AVM) or vascularized tumors. The current diagnostic pathway includes clinical examination, cranial MRI and additional DSA. The aim of this study was to evaluate the diagnostic impact of DSA in the diagnostic workup of patients with PT in comparison to MRI alone.
  
  
  METHODS
  Retrospectively, 54 consecutive patients with pulsatile tinnitus were evaluated. All patients had a diagnostic workup including cranial MRI and DSA. MRI examinations were blinded to the results of DSA and retrospectively analyzed in consensus by two experienced neuroradiologists. The MR-examinations were evaluated for each performed sequence separately: time-of-flight-angiography, ce-MRA, T2, ce-T1-sequence and ce-T1-sequence with fat saturation.
  
  
  RESULTS
  37 of the 54 patients revealed a pathology explaining PT on MRI, which was detected by the readers in 100% and proofed by means of DSA. 24 dAVF, four paraganglioma, two AVM and seven more pathologies were described. All patients without pathology on MRI did also not show any pathology in DSA.
  
  
  CONCLUSIONS
  MR imaging is sufficient to exclude pathology in patients with pulsatile tinnitus.
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Deuschl
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Göricke
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Gramsch
authors.affiliation: Clinic of Neurosurgery, University Hospital of Essen, Essen, Germany.
authors.forename: Neriman
authors.initials: N
authors.lastname: Özkan
authors.affiliation: Clinic of Otolaryngology, University Hospital of Essen, Essen, Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Lehnerdt
authors.affiliation: Clinic of Neurology, University Hospital of Essen, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kastrup
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ringelstein
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Essen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Schlamann
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000175:diagnosis*; D016208:Databases, Factual; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014012:Tinnitus / Q000175:diagnosis* / Q000209:etiology*