Which imaging technique is best to rule out vertebrobasilar insufficiency in cases of recurrent vertigo?

Magnetic resonance imaging (MRI) is the best imaging technique to rule out vertebrobasilar insufficiency, particularly in cases of recurrent vertigo. This is primarily because MRI provides detailed images of the brain and surrounding structures, enabling the visualization of any ischemic changes, lesions, or anomalies in the vertebrobasilar system that may contribute to vertigo. In cases where cervical or cranial vascular insufficiency is suspected, MRI can help identify such conditions, including stroke or transient ischemic attacks affecting the brainstem or cerebellum, areas that are crucial in the coordination of balance and spatial orientation.

In contrast, other methodologies like a carotid Doppler are specifically focused on the carotid arteries and may not adequately assess other critical vessels involved in the vertebrobasilar system. The Dix-Hallpike maneuver and the Epley maneuver are clinical tests primarily used to diagnose and manage benign paroxysmal positional vertigo (BPPV), rather than to investigate underlying vascular insufficiencies. These tests do not provide imaging information but rather assess how changes in head position affect symptoms. Thus, while they are useful for diagnosing BPPV, they would not help in ruling out vertebrobasilar insufficiency.