Temporal bone remodeling is an indicator of transverse sinus stenosis on computed tomography.

Purpose: The purpose of this study was to identify potential association between transverse sinus stenosis (TSS) and temporal bone thinning downstream of TSS on computed tomography (CT).

Materials and methods: Clinical and radiological data of patients with venous pulsatile tinnitus due to TSS (TSS group) and treated with stenting from 2019 to 2022 were retrospectively collected. An age-matched control group of patients with venous or neutral pulsatile tinnitus (control group) was built. CT measurements of temporal bone thickness were performed at the level of transverse-sigmoid sinus junction (E1) and the occipitomastoid suture (E2). E1; E2 and E1/E2 ratios obtained in TSS and control groups were compared.

Results: A total of 122 patients with venous pulsatile tinnitus were included. There were 56 patients with TSS (TSS group; 56 women; mean age, 35.5 ± 11.3 [standard deviation] years) and 66 patients without TSS (control group; 54 women; mean age, 37.7 ± 10.5 [standard deviation] years). E1 measurements and E1/E2 ratios on the symptomatic and dominant sides were significantly lower in the TSS group by comparison with the contralateral side of the same group (P < 0.05) and the ipsilateral side of the control group (P < 0.05). There were no differences in median E2 values between the TSS group (6.8 mm; range: 3.5-10.8 mm) and the control group (7.1 mm; range: 2.9-11.2 mm) (P = 0.098). E1 = 0 mm was found only in the TSS group. At receiver operating characteristic (ROC) analysis, an E1/E2 ratio threshold of 0.562 maximized the ability to predict presence of TSS. An E1/E2 ratio < 0.562 was predictive of symptomatic TSS with an accuracy of 74% (95% confidence interval: 65-82%). The AUC for the diagnosis of TSS was 0.807 (95% CI: 0.729-0.885).

Conclusion: Temporal bone thickness is significantly reduced downstream of the stenosis on the pulsatile tinnitus side and may be a good indicator of symptomatic TSS.