Prevalence and Radiologic Manifestations of Internal Jugular Venous Stenosis in Patients with Pulsatile Tinnitus: A Case-Control Study

BACKGROUND AND PURPOSE: The role of internal jugular venous stenosis (IJVS) in the development of pulsatile tinnitus (PT) is unclear. In this study, we aim to assess the prevalence of IJVS and to analyze the associated imaging findings in patients with and without PT. MATERIALS AND METHODS: We conducted a case-control study of consecutive adult patients with PT who underwent imaging evaluation with CT angiogram/CT venogram with contrast between February 2018 and March 2022. Age-and sex-matched controls who received CTA and/or CTV for an indication other than PT, headache, or visual disturbance were included. We compared the clinical and imaging findings between the PT and control groups. The prevalence and severity of IJVS were also analyzed. RESULTS: A total of 148 patients with PT and 98 control patients were included. There was no difference in the prevalence of IJVS between groups (p = 0.19). No difference in stenosis grade was observed between patients with PT and those in the control group with IJVS (p = 0.61). Empty sella turcica, optic nerve tortuosity, optic nerve sheath prominence, transverse sinus stenosis (TSS), and sigmoid sinus wall abnormalities (SSWA) were greater in the PT group than in controls (all p < 0.01). Among PT patients, imaging findings of IIH were not associated with IJVS. Among patients with IJVS, TSS and empty sella turcica were more common in PT patients than controls. CONCLUSIONS: IJVS was common in patients with PT and controls with similar prevalence and severity observed in both groups. TSS and SSWA were significantly more common in PT patients compared to controls. Among PT patients, there was no association between imaging findings of IIH and IJVS. Other causes of PT should be sought before considering intervention for IJVS. ABBREVIATIONS: IIH = idiopathic intracranial hypertension; IJVS = internal jugular venous stenosis; LP = lumbar puncture; PT = pulsatile tinnitus; SSWA = sigmoid sinus wall abnormalities; TSS = transverse sinus stenosis