The twinkling artifact is capricious at best, often not seen even behind stones and calcifications that are obvious using conventional B-mode ultrasound. This is no small part because, optimal parameters for detecting it remain controversial, some authors arguing for high PRF 1 while other studies demonstrating the benefits of low PRF 2. The importance of the appropriate positioning of the focus (at least at the level or slightly below the lesion) is however generally agreed upon. The twinkling artifact is a finicky beast and the parameters required to facilitate it depend largely on the manufacturer and the type of transducer. Factory presets are usually not optimal for visualizing it, thus, for a new device it is best to figure out for ourselves the optimal PRF and color Doppler gain that make it stand out more.