목적: Vascular lesions are one of the most frequent causes of pulsatile tinnitus. To make accurate diagnosis and treatment plan, appropriate imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI) or angiography is mandatory. In this study, we aimed to analyze the radiologic findings and workup modalities in patients with vascular pulsatile tinnitus and to suggest optimal diagnostic imaging modalities. 방법:Retrospective medical records, radiologic workup and findings were reviewed in twenty-six patients with vascular pulsatile tinnitus. 결과:The spectrum of lesions detected as jugular bulb variants (10/26), sigmoid sinus diverticulum (6/26), dural aterio-venous fistula (4/26), aberrant carotid artery (2/26), some venous variants and internal carotid artery narrowing due to atherosclerosis. Most of them were enough to diagnose with temporal bone CT only after manual neck compression test. Some of other patients who had an arterio-venous fistula or internal carotid artery stenosis were needed more evaluation such as MRI and angiography 결론:After simple manual neck compression test, temporal bone CT only is enough to diagnose the vascular pulsatile tinnitus for especially venous origin. So, high suggestion of venous origin pulsatile tinnitus could be helpful to reduce the unnecessary image workup.