The vestibular system, essential for balance and spatial orientation, spans from the inner ear to various brain regions. Advances in imaging techniques have significantly enhanced our ability to diagnose and treat vestibular disorders. This review explores the anatomy of the vestibular system and evaluates the roles of high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing structural abnormalities. CT is particularly useful for identifying bony labyrinth anomalies, temporal bone fractures, and superior canal dehiscence, though it has limitations in visualizing membranous labyrinth lesions. MRI, with its superior soft tissue resolution, is preferred for detecting retrocochlear lesions such as vestibular schwannomas, cerebellopontine angle tumors, and demyelinating diseases in the posterior fossa. Functional MRI also offers insights into the vestibular system’s functional aspects. The review emphasizes the increasing importance of imaging diagnostics in the effective management of vestibular system diseases, highlighting both structural and functional imaging modalities to improve patient outcomes.

The vestibular cortex is a distributed network of multisensory areas that plays a crucial role in balance, posture, and spatial orientation. The core region of the vestibular cortex is the parietoinsular vestibular cortex (PIVC), which is located at the junction between the posterior insula, parietal operculum, and retroinsular region. The PIVC is connected to other vestibular areas, the primary and secondary somatosensory cortices, and the premotor and posterior parietal cortices. It also sends projections to the vestibular nuclei in the brainstem. The PIVC is a multisensory region that integrates vestibular, visual, and somatosensory information to create a representation of head-in-space motion, which is used to control eye movements, posture, and balance. Other regions of the vestibular cortex include the primary somatosensory, posterior parietal, and frontal cortices. The primary somatosensory cortex is involved in processing information about touch and body position. The posterior parietal cortex is involved in integrating vestibular, visual, and somatosensory information to create a representation of spatial orientation. The frontal cortex is involved in controlling posture, and eye movements. The various methods used to stimulate the vestibular receptors in neuroimaging studies include caloric vestibular stimulation (CVS), galvanic vestibular stimulation (GVS), and auditory vestibular stimulation (AVS). CVS uses warm or cold water or air to stimulate the semicircular canals, GVS uses a weak electrical current to stimulate the vestibular nerve, and AVS uses high-intensity clicks or short tone bursts to stimulate the otolithic receptors.

Citations

• Vestibular Agnosia: Toward a Better Understanding of Its Mechanisms
  Assan Mary Cedras, Jonathan Dion, Arnaud Saj, François Champoux, Maxime Maheu
  Audiology Research.2025; 15(1): 15.     CrossRef
• Posture‐Dependent Modulation of Interoceptive Processing in Young Male Participants: A Heartbeat‐Evoked Potential Study
  Mayu Dohata, Naotsugu Kaneko, Ryogo Takahashi, Yuya Suzuki, Kimitaka Nakazawa
  European Journal of Neuroscience.2025;[Epub]     CrossRef