The aim of this study was to evaluate the diagnostic value of modern imaging tools in pulsatile tinnitus, which might be apparent in a variety of different diseases. While computed tomography (CT) and digital subtraction angiography (DSA) have been the methods of choice in the diagnostic management of this symptom and its related diseases, the technical progress in the development of MRI and MRA highly recommends these techniques as additional yet sufficient imaging tools. The authors demonstrate 2 representative cases of pulsatile tinnitus (one patient with glomus tumour, one patient with jugular bulb deformity) and the adequate diagnostic procedure in terms of imaging tools. It is concluded that a routine MRI-examination might allow a diagnosis with high sensitivity and specificity. Still, digital subtraction angiography and computed tomography remain indispensable in the diagnostic management of pulsatile tinnitus.