Color and power Doppler twinkling artifacts from urinary stones: Clinical observations and phantom studies

OBJECTIVE. The purpose of this study was to determine whether color and power Doppler twinkling artifacts could be considered an additional diagnostic sonographic feature of urinary stones. SUBJECTS AND METHODS. A prospective study was performed in 32 patients with 20 renal stones and 16 ureteral stones to assess how often urinary stones show twinkling artifacts on Doppler sonography. Gray-scale images and color, power, and spectral Doppler images were obtained in all patients. All sonographic examinations were performed with a 3.5- or 5-MHz curvilinear phased array probe. The images were then analyzed for the presence, appearance, and intensity of the artifacts. Phantom experiments were performed with various kinds of urinary stones with high-megahertz linear phased array probes. The effects on the artifacts of the composition of the stones, of the Doppler velocity scale, and of the focal zone were investigated. RESULTS. Thirty (83%) of 36 urinary stones showed color and power Doppler twinkling artifacts, which appeared as a rapidly changing color complex seen persistently behind stones like a comet's rail. Twenty-two of 30 stones with the twinkling artifacts showed strong intensity artifacts. Spectra with saturated amplitude were obtained from all 30 stones showing color Doppler artifacts. In phantom experiments, the artifacts originated from all stones. The velocity range did not affect the artifacts, whereas focal zone did. CONCLUSION. Color Doppler twinkling artifacts from urinary stones occur frequently and may be considered an additional sonographic feature of urinary stones. The observation of these artifacts may be helpful in determining the presence of urinary stones.