In some studies the twinkling artifact was present in 83% of urinary stones. Presence of this artifact is sometimes beneficial, such as in cases of detection of urinary tract stones with indistinct echogenicity and poor posterior acoustic shadowing. Some newer articles describe this artifact as a phenomenon dependent on ultrasound machine settings (color-write priority, gray-scale gain, and pulse repetition frequency), motion of the object scanned with respect to the transducer, and equipment used . Earlier authors believed that this artifact was dependent on surface roughness. Twinkle artifact occurs behind highly reflective objects, particularly urinary tract stones. This artifact has been described behind calcifications in various tissues. It manifests itself as a color signal but without real flow behind the structures. Twinkling artifact is a color phenomenon visible behind a strongly reflecting interface such as urinary tract stones, parenchymal calcification or bones during color Doppler examination. Scintillation artifact, twinkle artifact. Inner Vision Women"s Ultrasound, 2201 Murphy Ave, Ste 203, Nashville, TN 37203, USA. All rights reserved.Fellow,, 2201 Murphy Ave, Ste 203, Nashville, TN 37203, USA Permanent position: Gynecological and Obstetrical Department, Central Military Hospital in Ruzomberok, Slovak Republic Kidney stone Nephrolithiasis Twinkle artifact Ultrasound.Ĭopyright © 2021 Journal of Pediatric Urology Company. The presence of TA should be weighed in the setting of other clinical and radiographic evidence of nephrolithiasis. This may be related to renal location and smaller stone size. Sensitivity, specificity, positive predictive value and negative predictive value of TA for detecting nephrolithiasis were 83%, 78%, 74% and 86% respectively.Ĭompared to the adult literature, TA in children has lower sensitivity, specificity and positive predictive value, but similar negative predictive value for diagnosing nephrolithiasis. The majority of confirmed stones were in the kidney (n = 40 82%) and mean size of confirmed stones on ultrasound was 5 mm (range 1.5-10). Nephrolithiasis was diagnosed using TA and confirmed on confirmatory studies for 49 ultrasounds. 135 patients had confirmatory information available (Summary Table). Sixty-nine had diffuse twinkle without echogenic focus and 224 showed TA with single echogenic focus. Stone was confirmed either by CT within 3 months of color Doppler ultrasound, visualization on ureteroscopy, or patient report of passing the stone.įive hundred and ninety-nine ultrasound reports were reviewed and 293 met inclusion criteria. Exclusion criteria were age >18, multiple echogenic foci or medullary calcinosis, no follow-up, or TA located outside the kidney or ureter. We reviewed renal ultrasound reports indicating presence or absence of TA associated with a single echogenic focus in the kidney or ureter. We sought to evaluate if TA is reliable for diagnosing nephrolithiasis in the pediatric population. TA has been shown to be highly predictive of nephrolithiasis in adults with renal colic and ureteral stones. Nephrolithiasis is detected on ultrasound by the presence of an echogenic focus, posterior acoustic shadowing and/or twinkle artifact (TA).
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