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Two patients with pulsatile tinnitus

Case Study
Casselman, Jan, M.D., Ph.D. Brugge, AZ St. Jan AV Belgium

TOF assists in diagnosis of two patients with left-sided tinnitus

Patient history:

Patient 1, with a dural fistula, presented with pulsatile tinnitus on the left side.

Patient 2, with a glomus jugulare tumor, also presented with pulsatile tinnitus on the left side.

MR examination:

TOF imaging was performed using the SENSE Head/Neck coil together with SENSE and CLEAR.

MR images and interpretation for patient 1:

High resolution TOF
High resolution TOF


This unenhanced TOF image depicts fast flow in the left sigmoid sinus (black arrow), indicating the presence of a possible arteriovenous dural fistula. Note the normal low signal intensity in the right sigmoid sinus (white arrow).



MIP, cranio-caudal view MIP, lateral view
MIP, cranio-caudal view
MIP, lateral view


Three-dimensional reconstructions of the unenhanced TOF images are created, which demonstrate fast flow in the sigmoid sinus (arrow). This is found to be caused by a fistula originating from the middle meningeal artery (white arrowheads) and the occipital artery (gray arrowheads). This diagnosis was made on the 5-minute TOF sequence.

MR images and interpretation for patient 2:

Post-contrast TOF
Post-contrast TOF


On this axial Gd-enhanced TOF image through the left jugular foramen, a hypointense lesion (white arrowheads) is seen in the enhancing jugular bulb. Fast flow of a high signal intensity (black arrowhead) is visualized inside the lesion. A glomus tumor was later confirmed. Note the high signal intensity flow in the carotid artery (white arrow).

Working diagnosis

Patient 1: A fistula originating from the middle meningeal artery and occipital artery.

Patient 2: Found to have a glomerus tumor.

Impact of coil use and SENSE/CLEAR:

Acquiring high resolution images in an acceptable time, is enabled by: 

  1. Using SENSE enables acquisition of  images with excellent SNR and image detail in just about four minutes.
  2. Using CLEAR allows signal homogenization from left to right without a drop-off at the center.



More information about head and neck MR imaging can be found in the Clinical View article by Dr. Casselman:

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Oct 26, 2006

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Case Study
Intera 1.5T
Release 1 (FreeWave), Release 10, Release 11, Release 12, Release 2 (FreeWave), Release 8, Release 9
Explorer / Nova Dual, gradients, Master / Nova, Omni / Stellar, Power / Pulsar
Neck, Neuro

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