OBJECTIVE: The aim of this review is to illustrate the sonographic features that can be detected in vertebral artery (VA) diseases. METHODS: We conducted a review of sonographic findings in VA diseases. RESULTS: Various VA diseases are described, and sonographic techniques and features are discussed. CONCLUSIONS: Posterior circulation vascular imaging can be performed by means of various neuroimaging techniques. Intra-arterial angiography remains the reference standard. The use of this technique has become even more widespread since it has become possible to perform endovascular procedures; it is, however, an invasive procedure that is associated with a not irrelevant level of risk. Computed tomographic angiography and magnetic resonance angiography with and without contrast agents have been proposed as less invasive alternatives, although these techniques can only be performed in the radiology unit and may not be readily available in daily clinical management. Sonography, which combines an extracranial and intracranial evaluation, is highly suited to the assessment of the vertebrobasilar system on account of its widespread availability and its unique capacity to study real-time hemodynamics. Furthermore, new sonographic applications and sonographic contrast agents have improved the sensitivity and specificity of this technique with regard to diagnostic accuracy for the posterior circulation.