Abstract Details

Title The Role of Noninvasive Imaging in the Diagnostic Workup for Pulsatile Tinnitus

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 182

Objective We sought to characterize the diagnostic yield and impact of advanced noninvasive imaging in patients with pulsatile tinnitus (PT).

Background Patients with PT are often referred for digital subtraction angiography (DSA) because PT can be caused by cerebrovascular conditions including arteriovenous fistulae. The role of advanced noninvasive imaging, including magnetic resonance venography (MRV) and time-resolved magnetic resonance angiography (MRA), in the diagnostic evaluation of PT remains unclear.

Design/Methods We performed a retrospective cohort study of patients presenting for diagnostic evaluation of PT at our institution. Two independent examiners evaluated the validity of the ICD-10 diagnosis code (H93.Ax) for PT in a random sample of 25 patients with this diagnosis code and 25 patients with other cerebrovascular diagnosis codes. We then used H93.Ax to identify all patients seen at our institution for evaluation of PT from January 2018 to March 2020. Patients with non-pulsatile tinnitus and established etiologic diagnoses (i.e., idiopathic intracranial hypertension) presenting for treatment were excluded. Systematic chart abstraction was performed with attention to diagnostic workup, diagnoses, treatments, and outcomes, which we summarized using standard descriptive statistics.

Results The ICD-10 code for PT was 100% sensitive and 86% specific for PT at our institution. We identified 226 patients with PT. The mean age was 48 (SD, 15) years, and 74% were women. The average body mass index was 27.6 kg/m², and common comorbidities include hypertension (39%), hyperlipidemia (25%), migraine (17%), and diabetes (8%). Of the 226 patients, 134 (59%) did not undergo DSA but underwent MRV (90%) and/or MRA (90%). Of these 134 patients, 80 (60%) were provided an etiologic diagnosis. The top two diagnoses were venous sinus stenosis (75%) and diverticulum (13%). 16 (80%) of 20 patients who subsequently underwent endovascular treatment achieved full resolution of PT.

Conclusions Our findings support a greater role for noninvasive cerebrovascular imaging in patients with PT.

Authors/Disclosures
Alice Tao PRESENTER	Ms. Tao has nothing to disclose.
Neal S. Parikh, MD (Alnylam Pharmaceuticals)	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has or had stock in Alnylam Pharmaceuticals.
	No disclosure on file

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Abstract Details