In a patient with chronic vertigo, what is the best imaging test to order?

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Evaluating chronic vertigo requires looking for central causes as well as inner ear pathology, and MRI of the head provides the best overall view. It has superior soft-tissue contrast and can visualize the brainstem, cerebellopontine angle, and inner ear structures in great detail. This makes it the most sensitive test for detecting subtle lesions that can underlie chronic vertigo, such as vestibular schwannomas, other CPA tumors, demyelinating plaques, or small infarcts.

CT head, while good for bone detail and faster in acute settings, misses small soft-tissue lesions in the posterior fossa and delicate inner-ear structures. A plain XR head offers even less useful information for vertigo. An audiogram measures hearing function but does not image the brain or inner ear anatomy, so it cannot replace imaging when a central cause is suspected. Therefore, MRI head is the best imaging choice in this scenario.