Twinkling artifact

Twinkling artifact is seen with color flow Doppler ultrasound 1. It occurs as a focus of alternating colors on Doppler signal behind a reflective object (such as a calculus), which gives the appearance of turbulent blood flow 2. It appears with or without an associated color comet-tail artifact 3.

The underlying mechanism of this artifact is thought to be a result of inherent noise within the ultrasound scanner, specifically phase (a.k.a. clock) jitter within the Doppler electronics 10.

Twinkling artifact is more sensitive for detection of small stones (e.g. urolithiasis, cholelithiasis) than is acoustic shadowing. It is most pronounced when the reflecting surface is rough and highly dependent on machine setting:

  • when the focal zone is located below a rough reflecting surface, the twinkling artifact becomes more obvious than when it is above it 4
  • increased pulse repetition frequency facilitates better visualization of the artifact 8,9

The presence of renal twinkling artifact on sonography has a high positive predictive value (78%) for the presence of nephrolithiasis at unenhanced CT 10.

History and etymology

The first description of twinkling artifact was by the French radiologist Alain Rahmouni (1957-2018) 7 et al in 1996 5.

See also

Imaging technology
Inspired signs

Article information

rID: 21828
Synonyms or Alternate Spellings:
  • Twinkling artefacts
  • Twinkling artefact
  • Twinkle artifacts
  • Twinkle artifact
  • Twinkle artefact
  • Twinkle artefacts
  • Twinkle artefact - ultrasound

Support Radiopaedia and see fewer ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3
    Drag here to reorder.
  • Case 4: from a foreign body
    Drag here to reorder.
  • Case 5: medullary nephrocalcinosis
    Drag here to reorder.
  • Case 6: vesicoureteric junction stone
    Drag here to reorder.
  • Case 7: vesicoureteric junction calculus
    Drag here to reorder.
  • Case 8: metal foreign body in arm
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.