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Color and Power Doppler Twinkling Artifacts from Urinary Stones

Clinical Observations and Phantom Studies

Jae Young Lee1, Seung Hyup Kim1, Jeong Yeon Cho2 and Daehee Han1

1 Department of Radiology, Seoul National University College of Medicine, The Institute of Radiation Medicine, 28, Yongon-dong, Chongno-ku, Seoul, 110-744, Korea.
2 Department of Radiology, Sungkyunkwan University School of Medicine, Samsung Cheil Hospital, 1-19, Mookjung-dong, Chung-Ku, Seoul, 100-380, Korea.



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  		Fig. 1A. —45-year-old woman with 1.5-cm renal stone. Sonogram shows well-marginated hyperechoic lesion (arrow) with indiscrete acoustic shadowing.

 


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  		Fig. 1B. —45-year-old woman with 1.5-cm renal stone. Color Doppler sonogram shows rapidly changing color band (arrow) seen persistently behind stone with comet's tail appearance.

 


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  		Fig. 1C. —45-year-old woman with 1.5-cm renal stone. Power Doppler sonogram shows artifactual power signal (arrow) behind and around stone.

 


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  		Fig. 1D. —45-year-old woman with 1.5-cm renal stone. Spectral Doppler sonogram with sample volume located in stone shows artifactual spectral signal with saturated amplitude.

 


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  		Fig. 2A. —51-year-old woman with 1-cm ureteral stone. Sonogram shows echogenic lesion (solid arrow) near lower pole of right kidney. It is poorly distinguished from adjacent echogenic tissue (open arrow) and does not show discrete posterior acoustic shadowing. Therefore, it is not easy to determine that this lesion is ureteral stone.

 


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  		Fig. 2B. —51-year-old woman with 1-cm ureteral stone. Color Doppler sonogram shows twinkling artifact (arrow) from echogenic lesion.

 


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  		Fig. 2C. —51-year-old woman with 1-cm ureteral stone. Artifactual signal (arrow) is also seen on power Doppler sonogram.

 


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  		Fig. 2D. —51-year-old woman with 1-cm ureteral stone. On spectral sonogram, spectrum is composed of close vertical bands without definable waveform.

 


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  		Fig. 3A. —35-year-old man with 0.9-cm stone near ureterovesical junction (UVJ). Axial sonogram of bladder shows that right UVJ (arrow) is swollen, and right UVJ area is slightly more echogenic, compared with opposite site. However, existence of ureteral stone is not definite because of surrounding echogenic tissue and indiscrete posterior acoustic shadowing.

 


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  		Fig. 3B. —35-year-old man with 0.9-cm stone near ureterovesical junction (UVJ). Color Doppler sonogram shows prominent twinkling artifact (arrow) from right UVJ area.

 


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  		Fig. 3C. —35-year-old man with 0.9-cm stone near ureterovesical junction (UVJ). Spectral Doppler sonogram with sample volume located in right UVJ area shows artifactual spectral signal with saturated amplitude.

 


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  		Fig. 4A. —Calcium oxalate stone (0.7 cm) used as phantom and located between gel pads. Color Doppler sonogram obtained with 7.5-MHz linear array transducer shows that artifact is not produced by stone when focal zone (arrowhead) is located above stone.

 


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  		Fig. 4B. —Calcium oxalate stone (0.7 cm) used as phantom and located between gel pads. When focal zone (arrowhead) is below stone, color Doppler sonogram shows rapidly changing and continuing color bands.

 


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  		Fig. 4C. —Calcium oxalate stone (0.7 cm) used as phantom and located between gel pads. Color Doppler sonogram, obtained when focal zone (arrowhead) is moved below stone, fails to show prominent change of artifact.

 

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