Color Doppler twinkling artifact: Possible mechanisms and clinical potential

In the color Doppler mode of ultrasonography, a rapidly changing mixture of red and blue colors referred to as ‘twinkling artifact’ (TA) may appear for a stationary hyperechogenic target. This introduces ambiguity in diagnosis as well as provides conclusive information. We reviewed the possible mechanisms, and also illustrated the clinical potential in the detection of pathological sites associated with calculi, calcifications, cacinoses and fibroses and foreign bodies such as surgical clips, catheters, and guiding needles which were inconclusive in conventional grayscale sonograms. In order to increase the clinical utility of TA, a practical means to enhance TA was suggested which leads to a ‘TA mode’ to be implemented in a clinical scanner.