Diagnostic value of colour Doppler twinkling artefact in sites negative for stones on B mode renal sonography

The aim of the study was to investigate the diagnostic value of the colour Doppler twinkling artefact (TA) in renal stone disease. To enhance the evidence of TA, a preliminary in vitro study was performed to optimise the setting of colour Doppler sonography. In the in vitro study, an oxen kidney was examined using an high-frequency (12.5 MHz) linear array probe in a water bath before and after the inoculation of an aliquot of powder obtained by fragmentation of a calcium oxalate stone. In the clinical study, 67 patients with diagnosis of urinary stone based on B-mode sonography and 67 matched control subjects were examined with colour Doppler sonography using a low-frequency (2.5 MHz) curvilinear phased array probe. In vitro, the injection of calcium oxalate powder in a bovine kidney sample induced the appearance of spots without any back shadowing appearance on B mode but with a large number of TA on colour Doppler. In vivo, TA was much more frequent in patients with stone disease (95.5%) compared to controls (9.0%) (P < 0.001). TA was highly associated to renal stone disease and was also present in renal areas where a stone was undetected with B mode approach suggesting its diagnostic role although further studies are needed to confirm its accuracy. The type of instrumentation and its setting is crucial to obtain reproducible results.