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)

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.