Twinkling artifact in small animal color-Doppler sonography

Twinkling artifact is a recently described color-Doppler phenomenon that has not been studied in the veterinary field. Our purpose was to assess the grade of the artifact in vitro with varying urolith compositions, and to evaluate its potential role in clinical practice. Five canine and feline uroliths types of 100% mineral composition were studied in vitro with color-Doppler sonography, and a prospective study was performed in 41 patients with renal, bladder, gallbladder, or digestive focal hyperechogenicities. The images were analyzed for the presence and the grade of the artifact. Phantom study demonstrated the constant occurrence of the artifact regardless of the mineral composition of uroliths. Mottled and rough surfaced stones produced higher grades of twinkling artifact. High-grade, color-twinkling artifact generated by stones occured frequently in vivo. Bladder crystalluria was more frequently detected by artifact visualization than sample urinalysis performed by cystocentesis. In veterinary medicine, twinkling artifact may thus be considered an additional sonographic feature of urinary stones, and can lead to a more appropriate management of patients presenting gray-scale sonographic focal hyperechogenicities.