Usefulness of Twinkling Artifacts in Color Doppler Ultrasonography

컬러 도플러 초음파에서 Twinkling artifacts의 유용성

  • 심현선 (고려대학교 보건과학대학 방사선학과/인구보건복지협회) ;
  • 권경태 (동남보건대학교 방사선과)
  • Received : 2016.06.27
  • Accepted : 2016.08.01
  • Published : 2016.10.28


The aim of the study was to investigate the diagnostic value of the color Doppler twinkling artifact in disease of urinary system. The intensity of twinkling artifact(TA) with color Doppler was classified into 3 levels, 0(non-TA) to 3(distinct TA). In the in vitro study, acorn jelly with various materials on top was examined using color Doppler at B-mode sonography in a water bath for TA. 31 patients with diagnosis of urinary calculi(renal stones 16, urinary stones 15) based on B-mode sonography were studied in vivo for TA. The materials with rough surfaces such as salt, screw and cubics at B-mode sonography with color Doppler contributed to causing TA. At B-mode sonography without color Doppler 37% of renal stones and 60% of ureter stones were detected. but at B-mode sonography with color Doppler TA was demonstrated for all cases. Superficial roughness of materials affected occurrence of TA at B-mode sonography with color Doppler. Therefore, TA at B-mode sonography without color Doppler could play a role in confident diagnosis of the disease of urinary system.


Color Doppler;Renal Stone;Twinkling Artifact;Ureter Stone;Urinary Calculi


  1. 예석준, 유은상, 박윤규, "요로결석의 성분분석 : 20년간의 변화," 대한비뇨기과학회지, 제48권, p.1285, 2007.
  2. T. Alberto, M. Paolo, C. Fortunato, C. Luciana, A. Simeone, and T. Alberto, "Diagnostic value of colour Doppler twinkling artefact in sites negative for stones on B-mode renal sonography," Urol. Res., Vol.35, pp.313-317, 2007.
  3. J. Y. Lee, S. H. Kim, J. Y. Cho, and D. Han, "Color and power Doppler twinkling artifact from urinary stones: clinical observations and phantom studies," Am. J. Roentgenolgy, Vol.176, No.6, pp.1441-1445, 2001.
  4. F. W. Kremkau and K. J. W. Taylor, "artifact in Ultrasound imaging," J. Ultrasound Med., Vol.5, pp.227-230, 1986.
  5. A. Kamaya, T. Tuthill, and J. M. Rubin, "Twinkling Artifact on color Doppler sonography: Dependence on machine parameters and Underlying cause," Am. J. Roentgenolgy, Vol.180, pp.215-222, 2003.
  6. A. Rahmouni, R. Bargoin, A. Herment, N. Bargoin, and N. Vasile, "Color Doppler twinkling artifact in hyperechoic regions," Radiology, Vol.199, pp.269-271, 1996.
  7. 신형철, "The Usefulness of Twinkling Artifact on ultrasonography in differential diagnosis of stone and air : in vitro study = 초음파상 담도계 결석과 공기의 감별에 있어서 twinkling artifact의 유용성 : in vitro 연구," 순천향대대학원, 박사, pp.1-26, 2004.
  8. A. James, "Essential of Ultrasound Physics," 1st ed. Mosby, Vol.109, 1996.
  9. T. Tsao, R. Kang, Y. Tyan, M. Gueng, T. Lee, and S. Lee, "Color Doppler Twinkling Artifact related to Chronic Pancreatitis with Parenchymal Calcification," Acta Radiologica, Vol.47, pp.547-548, 2006.
  10. 손철호, 이정현, 조경식, "색채도플러 초음파에서 발생하는 Twinkling 인공음영 : 생체 외 실험에서 결석의 종류와 인공음영 발생과의 관계," 대한초음파의학회지, 제21권, pp.213-218, 2002.
  11. N. Chelfouh, N. Grenier, D. Higueret, H . Trillaud, O. Levantal, J. L. Pariente, and P. Ballanger, "Characterization of urinary calculi: in vitro study of "twinkling artifact"revealed by color-flow sonography," Am. J. Roentgenolgy, Vol.171, No.4, pp.1055-1060, 1998.
  12. M. Michael, F, Aigner, L. Pallwein, G. M. Pinggera, R. Neururer, P. Rehder, and F. Frauscher, "Sonographic Detection of Renal and Ureteral Stones. Value of the Twinkling Sign," International Braz J. Urol., Vol.35, No.5, pp.532-539, 2009.
  13. S. K. Aytac and H. Ozcan, "Effect of color Doppler system on the twinkling sign associated with urinary tract calculi," J. Clin. Ultrasound, Vol.27, pp.433-439, 1999.<433::AID-JCU4>3.0.CO;2-1
  14. R. D. Jonathan, Mariam Kappil, J. W. William et al. "Sonographic Twinkling Artifact for Renal Calculus Detection: Correlation with CT," Radiology, Vol.259, No.3, pp.911-916, 2011.
  15. 이재영, 김승협, 이학종, 김성현, "링 다운 현상에 의한 색 도플러 인공음영: 임상과 시험모델에서의 관찰," 대한초음파의학회지, 추계초록집, 제16 권, 1996.