Twinkling artifact on color Doppler ultrasound: an advantage or a pitfall?

Abstract

The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered.

Distinguishing a Trichilemmal Cyst From a Pilomatricoma With Ultrasound

“…Color Doppler images can show a twinkling artifact produced behind echogenic foci in some cases, which appears as a rapidly changing mixture of red and blue Doppler signals behind a rough, strongly reflective medium . The twinkling artifact can help radiologists recognize echogenic foci, which are not as obvious in grayscale US.…”

“…The twinkling artifact can help radiologists recognize echogenic foci, which are not as obvious in grayscale US. Radiologists should avoid confusing the twinkling artifact with vascular flow; however, spectral Doppler imaging shows a broadband heterogeneous signal representing noise rather than a flow spectrum …”

Twinkle, twinkle little stone: an artifact improves the ultrasound performance!

“…The twinkling artifact (TwA), also called "the color comet tail artifact", is a complex phenomenon, an intense color signal produced by calcifications in different organs [3,4]. The signal is persistent even if the pulse repetition frequency (PRF) is adjusted to higher levels.…”

Noninvasive Prediction of Renal Stone Surface Irregularities by Numerical Analysis of the Color Doppler Twinkling Artifact: An Ex Vivo Study

“…Since its introduction in 1996, the diagnostic value of the twinkling artifact on color Doppler US has been investigated in the field of urology . This study was concerned with the noninvasive prediction of roughness levels of kidney stones with the use of quantitative analysis and measurement of their corresponding twinkling artifacts.…”

“…Since its introduction in 1996, the diagnostic value of the twinkling artifact on color Doppler US has been investigated in the field of urology. 10,36,[40][41][42][43][44][45][46][47][48] This study was concerned with the noninvasive prediction of roughness levels of kidney stones with the use of quantitative analysis and measurement of their corresponding twinkling artifacts. The clinical advantage is for the sake of the correlation between renal stone morphologic characteristics and their fragility, 49 which can determine the effectiveness of treatment.…”