Microcalcifications in the breast detected by a color Doppler method using twinkling artifacts: some important discussions based on clinical cases and experiments with a new ultrasound modality called multidetector-ultrasonography (MD-US)

Abstract

The twinkling artifact is well known as a color Doppler artifact but it is still an unresolved phenomenon [Rahmouni et al., Radiology 1996;199:269-271 ; Atan et al., Astas Urol Esp 2001;35:396-402; Kamaya et al., AJR 2003;80:215-222]. Many factors affect the appearance of the twinkling artifact, such as the surface roughness of stones creating multiple reflections and a form of intrinsic noise known as clock jitter within the Doppler circuitry of the ultrasound equipment. However, no studies have reported on the twinkling artifact of breast microcalcifications. While considering these premises, I detected microcalcifications in the breast using twinkling artifacts that could not be detected on B-mode imaging. The twinkling artifact is a well-defined but not well-understood phenomenon that may assist in the detection of calcified foci. The phenomenon of the twinkling artifact is discussed here with regard to prospectively and retrospectively studied cases including experiments with a new ultrasound modality called multidetector-ultrasonography (MD-US). MD-US using detectability of the twinkling artifact in microcalcifications of the breast may play an important role in breast screening.

3D microcalcification detection using a color Doppler twinkling artifact with optimized transmit conditions: Preliminary results

“…However, due to uncertain mechanisms of TAs, most previous studies have focused only on identifying the effect of US machine imaging parameters (e.g., color gain, electrical noise, or pulse repetition frequency) in large calcifications (a few millimeters) 8–11 . For micron‐size calcifications (e.g., breast MCs), only a small number of studies have been reported since current CDI is limited in consistently presenting TA signals from random distributions 6,12,13 . A few case studies based on conventional CDI were conducted to identify the usefulness of TAs in detecting breast MCs, and the studies discussed the potential for improving breast screening or US‐guided biopsies 12,13 .…”

“…[8][9][10][11] For micron-size calcifications (e.g., breast MCs), only a small number of studies have been reported since current CDI is limited in consistently presenting TA signals from random distributions. 6,12,13 A few case studies based on conventional CDI were conducted to identify the usefulness of TAs in detecting breast MCs, and the studies discussed the potential for improving breast screening or US-guided biopsies. 12,13 However, these studies also depend on imaging parameters in commercial US systems and are deficient for a detailed analysis based on the physical mechanism of TAs.…”

“…6,12,13 A few case studies based on conventional CDI were conducted to identify the usefulness of TAs in detecting breast MCs, and the studies discussed the potential for improving breast screening or US-guided biopsies. 12,13 However, these studies also depend on imaging parameters in commercial US systems and are deficient for a detailed analysis based on the physical mechanism of TAs. On the other hand, PDI with an acoustic resonance technique (vibrator) was introduced to detect calcium particles, and the approach was compared with radiography.…”

Feasibility study using multifocal Doppler twinkling artifacts to detect suspicious microcalcifications in ex vivo specimens of breast cancer on US

“…Although various studies have suggested that twinkling artifacts on color Doppler and power Doppler imaging can be used effectively to detect calcification (e.g., kidney or urinary stones) 7 , only a few studies have investigated twinkling artifacts in breast microcalcifications 9 , 10 . As breast microcalcifications are small in size (< 1 mm) and are more randomly distributed, current color Doppler imaging cannot consistently present twinkling artifacts 11 .…”

“…Other studies have investigated various methods to detect calcifications on US, including the use of twinkling artifacts on color Doppler imaging (CDI) and power Doppler imaging 7 , 8 . However, it is difficult to consistently present twinkling artifact signals from randomly distributed micron-size calcifications (e.g., breast microcalcifications) with current CDI and as a result, only a few studies have applied CDI to microcalcifications 9 , 10 . In a previous report, we developed a new microcalcification detection technique using real-time multifocal Doppler twinkling artifact (MDTA) imaging, and reported comparable detection rates for microcalcifications compared to mammography in phantom studies 11 .…”