Twinkling artifact
Last revised by Caroline Rutten
on 30 Dec 2023
Citation, DOI, disclosures and article data
Citation:
Hosn S, Rutten C, Murphy A, et al. Twinkling artifact. Reference article, Radiopaedia.org (Accessed on 20 Mar 2025) https://doi.org/10.53347/rID-21828
Permalink:
rID:
21828
Article created:
20 Feb 2013,
Saeed Soltany Hosn
Disclosures:
At the time the article was created Saeed Soltany Hosn had no recorded disclosures.
View Saeed Soltany Hosn's current disclosures
Last revised:
30 Dec 2023,
Caroline Rutten
Disclosures:
At the time the article was last revised Caroline Rutten had no financial relationships to ineligible companies to disclose.
View Caroline Rutten's current disclosures
Revisions:
41 times, by
28 contributors -
see full revision history and disclosures
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Synonyms:
- Twinkle artefacts
- Twinkle artefact - ultrasound
- Twinkle artefact
- Twinkle artifact
- Twinkle artifacts
- Twinkling artefact
- Twinkling artefacts
Twinkling artifact is seen with color flow Doppler ultrasound 1. It occurs as a focus of alternating colors on Doppler signal behind a reflective object (such as a calculus or air), which gives the appearance of turbulent blood flow 2. It appears with or without an associated color comet tail artifact 3.
The underlying mechanism of this artifact is thought to be a result of inherent noise within the ultrasound scanner, specifically phase (a.k.a. clock) jitter within the Doppler electronics 10.
Twinkling artifact is more sensitive for detection of small stones (e.g. urolithiasis, cholelithiasis) than is acoustic shadowing. It is most pronounced when the reflecting surface is rough and highly dependent on machine setting:
when the focal zone is located below a rough reflecting surface, the twinkling artifact becomes more obvious than when it is above it 4
decreased pulse repetition frequency facilitates better visualization of the artifact 8,9
The presence of renal twinkling artifact on sonography has a high positive predictive value (78%) for the presence of nephrolithiasis on unenhanced CT 10.
History and etymology
The first description of twinkling artifact was by the French radiologist Alain Rahmouni (1957-2018) 7 et al. in 1996 5.
See also
References
- 1. William E. Brant, Clyde A. Helms. Fundamentals of Diagnostic Radiology. (2007) ISBN: 9780781765183 - Google Books
- 2. Nagafuchi Y, Sumitomo S, Soroida Y et al. The Power Doppler Twinkling Artefact Associated with Periarticular Calcification Induced by Intra-Articular Corticosteroid Injection in Patients with Rheumatoid Arthritis. Ann Rheum Dis. 2013;72(7):1267-9. doi:10.1136/annrheumdis-2012-202897 - Pubmed
- 3. Dillman J, Kappil M, Weadock W et al. Sonographic Twinkling Artifact for Renal Calculus Detection: Correlation with CT. Radiology. 2011;259(3):911-6. doi:10.1148/radiol.11102128 - Pubmed
- 4. Lee J, Kim S, Cho J, Han D. Color and Power Doppler Twinkling Artifacts from Urinary Stones. AJR Am J Roentgenol. 2001;176(6):1441-5. doi:10.2214/ajr.176.6.1761441 - Pubmed
- 5. Rahmouni A, Bargoin R, Herment A, Bargoin N, Vasile N. Color Doppler Twinkling Artifact in Hyperechoic Regions. Radiology. 1996;199(1):269-71. doi:10.1148/radiology.199.1.8633158 - Pubmed
- 6. Yang J, Kang G, Choi M. The Role of the Acoustic Radiation Force in Color Doppler Twinkling Artifacts. Ultrasonography. 2015;34(2):109-14. doi:10.14366/usg.14065 - Pubmed
- 7. Hacein-Bey L. Alain Rahmouni, MD. Radiology. 2018;289(1):276. doi:10.1148/radiol.2018184012
- 8. Wang M, Li J, Xiao J, Shi D, Zhang K. Systematic Analysis of Factors Related to Display of the Twinkling Artifact by a Phantom. J Ultrasound Med. 2011;30(11):1449-57. doi:10.7863/jum.2011.30.11.1449 - Pubmed
- 9. Hirsch, M. S., Tamara Palavecino, and Boris León. "Color Doppler twinkling artifact: A misunderstood yet useful sign." Rev Chil Radiol 2011;17(2):82-4. https://www.webcir.org/revistavirtual/articulos/septiembre11/chile/ch_ingles.pdf
- 10. Dillman J, Kappil M, Weadock W et al. Sonographic Twinkling Artifact for Renal Calculus Detection: Correlation with CT. Radiology. 2011;259(3):911-6. doi:10.1148/radiol.11102128 - Pubmed
Incoming Links
Articles:
Cases:
- Urethral stone
- Vesical stone
- Urinary bladder stones
- Orbital foreign body
- Duplex collecting system
- Twinkling artifact - renal stone
- Vesicoureteral junction calculus
- Paediatric bladder calculus
- Scrotal pearls within a small hydrocele
- Vesico-ureteric junction stone with resultant hydronephrosis
- Obstructive ureteric calculus
- Twinkling artifact of vesicoureteric junction calculus
- Vesicoureteric junction calculus - value of twinkling artifact
- Renal cyst - Bosniak type IIF (CEUS)
- Metal foreign body - thigh
- Twinkling artifact caused by calcified renal cyst
- Renal stone
- Bleeding duodenal ulcer and adenomyomatosis of gallbladder
- Twinkle artifact of renal calculi
- Foreign body - forearm
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