Color Doppler Twinkling Artifacts in Various Conditions During Abdominal and Pelvic Sonography

Objective. The aims of this study were to describe the mechanisms likely to be responsible for color Doppler twinkling artifacts and their associated machine factors and to illustrate the various conditions that cause twinkling artifacts and those pitfalls. Methods. We evaluated various sonographic machine-associated factors that influence artifact appearance and identified various conditions that display twinkling artifacts during abdominal and pelvic sonography. Results. The presence of twinkling artifacts was found to be dependent on focal zones, gray scale gains, color write priorities, and pulse repetition frequencies. Twinkling artifacts were found to be associated with calcified lesions in the liver, gallbladder adenomyomatosis, hepatic bile duct hamartoma, gallstones and choledocholithiasis, chronic pancreatitis, urinary stones, encrusted indwelling urinary stents, bowel gas, and metallic foreign bodies. However, some of the twinkling artifacts were found to be associated with false-negative and -positive results. Conclusions. Color Doppler twinkling artifacts are additional useful sonographic signs in the diagnosis of calcified lesions, urinary and biliary stones, gallbladder adenomyomatosis, and some miscellaneous conditions.