From the Guidelines
If you are experiencing dizziness, ordering a chest or neck scan is not typically the first step in evaluation, as stated in the guidelines by the American College of Radiology 1. Instead, your healthcare provider will likely start with a thorough medical history and physical examination to determine the cause of your dizziness. Dizziness can result from many conditions including inner ear problems (like benign paroxysmal positional vertigo or vestibular neuritis), cardiovascular issues, medication side effects, or neurological conditions.
Some key points to consider:
- The diagnostic yield of CT scans for dizziness is very low, approximately 2% 1.
- Imaging of the chest or neck would only be appropriate if your symptoms and examination findings suggest a specific problem in these areas that could explain your dizziness, such as a carotid artery stenosis, vertebrobasilar insufficiency, or a mass affecting blood flow.
- Your doctor might first recommend less invasive tests like blood pressure measurements, electrocardiogram (ECG), or specialized balance tests, as suggested by the clinical practice guidelines for benign paroxysmal positional vertigo (BPPV) 1.
- If these initial evaluations suggest a problem that could be visualized with imaging, then a CT scan or MRI might be ordered, but this should be done judiciously to avoid unnecessary radiation exposure and healthcare costs, as emphasized in the guidelines 1.
Overall, a stepwise diagnostic approach guided by your symptoms and examination findings is crucial in evaluating dizziness, and imaging studies should be reserved for cases where there is a strong clinical suspicion of a specific condition that would benefit from imaging, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1.
From the Research
Evaluation of Dizziness
- Dizziness is a common yet imprecise symptom that can be caused by various factors, including peripheral and central etiologies 2, 3.
- The evaluation of dizziness focuses on determining whether the etiology is peripheral or central, with peripheral etiologies being usually benign and central etiologies often requiring urgent treatment 2.
Role of Imaging in Dizziness Evaluation
- Laboratory testing and imaging are not required and are usually not helpful in the evaluation of dizziness 2.
- However, imaging may be helpful in certain cases, such as vertebral artery dissection, where computed tomography and magnetic resonance imaging can be used to evaluate the relationship between imaging features and clinical presentation 4.
- Advances in non-invasive imaging have placed magnetic resonance and computed tomography at the forefront of diagnosis for carotid and vertebral artery dissections 5.
Specific Conditions
- Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure, such as the Epley maneuver 2, 3.
- Vestibular rehabilitation is helpful in treating many peripheral and central etiologies of dizziness 3.
- Vertebral artery dissection can present with dizziness, headache, neurologic deficit, or altered mentality, and imaging findings can vary depending on the angiographic pattern 4.