Diagnostic Accuracy of Twinkling Artifact of Doppler Ultrasound in Predicting Urinary Tract Calculi Taking Ct Scan As Gold Standard.
Keywords:
Urinary Tract Calculi, Doppler Ultrasound, Computed Tomography, Twinkling ArtifactsAbstract
OBJECTIVES
This study aims to determine the diagnostic accuracy of the twinkling artifact of Doppler ultrasound in predicting urinary tract calculi by taking a CT scan as the gold standard in the patients presenting to the radiology department at Hayatabad Medical Complex Peshawar.
METHODOLOGY
A cross-sectional study was conducted in the Radiology Department of Hayatabad Medical Complex Peshawar in the duration of 22nd April 2021 to 22nd October 2021
A total of 206 suspected of having urinary tract calculi were included in the study consecutively and subjected to Doppler ultrasound followed by CT KUB.
RESULTS
The mean age of the sample was 42.3 + 9.1 years. 67% of the sample was male, and 33% were female. The mean duration of symptoms in our group of samples was 4.1 + 1.3 weeks. On twinkling artifacts with Doppler US, urinary tract calculi were observed in 53.4% of patients. In contrast, on follow-up CT KUB scans, urinary tract calculi were recorded in 73.3% of patients. The sensitivity of twinkling artifacts with Doppler US was found to be 71.5%, and the specificity was found to be 96.4%. The positive predictive value of the twinkling artifacts with Doppler US is 98.2%, and the negative predictive value is 55.2%.
CONCLUSION
Twinkling artifact on Doppler US has an acceptable sensitivity and specificity for detecting urinary tract calculi. As such, it is a useful radiological tool for diagnosing urinary tract stones in adults, and further studies are recommended to confirm its usefulness, particularly considering other explanatory effect modifiers.
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Pathan SA, Mitra B, Bhutta ZA, Qureshi I, Spencer E, Hameed AA, et al. A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia. Int J Emerg Med. 2018;11(1):1-.
Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H, et al. Epidemiology of urolithiasis in Asia. Asian J Urol. 2018;5(4):205-14.
Ganesan V, De S, Greene D, Torricelli FCM, Monga M. Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions? BJU International. 2016;119(3):464-9.
Simon JC, Sapozhnikov OA, Kreider W, Breshock M, Williams JC, Bailey MR. The role of trapped bubbles in kidney stone detection with the color Doppler ultrasound twinkling artifact. Phys Med Biol. 2018;63(2):025011-.
Masch WR, Cohan RH, Ellis JH, Dillman JR, Rubin JM, Davenport MS. Clinical Effectiveness of Prospectively Reported Sonographic Twinkling Artifact for the Diagnosis of Renal Calculus in Patients Without Known Urolithiasis. American Journal of Roentgenology. 2016;206(2):326-31.
Liu N, Zhang Y, Shan K, Yang R, Zhang X. Sonographic twinkling artifact for diagnosis of acute ureteral calculus. World J Urol. 2020;38(2):489-95.
Rodger F, Roditi G, Aboumarzouk Omar M. Diagnostic Accuracy of Low and Ultra-Low Dose CT for Identification of Urinary Tract Stones: A Systematic Review. Urologia Internationalis. 2018;100(4):375-85.
Rokni E, Zinck S, Simon JC. Evaluation of Stone Features That Cause the Color Doppler Ultrasound Twinkling Artifact. Ultrasound in Medicine & Biology. 2021;47(5):1310-8.
Leonov DV, Kulberg NS, Gromov AI, Morozov SP. Detection of Microcalcifications using the Ultrasound Doppler Twinkling Artifact. Biomedical Engineering. 2020;54(3):174-8.
Raza A, Zubair J. Diagnostic accuracy of transabdominal ultrasonography in Urolithiasis, keeping CT KUB as Gold standard. Journal of Biological and Allied Health Sciences. 2024;4:3-6.
Rokni E, Simon JC. The effect of crystal composition and environment on the color Doppler ultrasound twinkling artifact. Physics in Medicine & Biology. 2023;68(3):035021.
Wood BG, Urban MW. Detecting Kidney Stones Using Twinkling Artifacts: Survey of Kidney Stones with Varying Composition and Size. Ultrasound Med Biol. 2020;46(1):156-66.
Puttmann K, Dajusta D, Rehfuss AW. Does twinkle artifact truly represent a kidney stone on renal ultrasound? Journal of Pediatric Urology. 2021;17(4):475.e1-.e6.
Ray AA, Ghiculete D, Pace KT, Honey RJDA. Limitations to Ultrasound in the Detection and Measurement of Urinary Tract Calculi. Urology. 2010;76(2):295-300.
Kanno T, Kubota M, Sakamoto H, Nishiyama R, Okada T, Higashi Y, et al. The Efficacy of Ultrasonography for the Detection of Renal Stone. Urology. 2014;84(2):285-8.
Goertz JK, Lotterman S. Can the degree of hydronephrosis on ultrasound predict kidney stone size? The American Journal of Emergency Medicine. 2010;28(7):813-6.
Pichler R, Skradski V, Aigner F, Leonhartsberger N, Steiner H. In young adults with a low body mass index ultrasonography is sufficient as a diagnostic tool for ureteric stones. BJU International. 2011;109(5):770-4.
Gliga ML, Chirila CN, Podeanu DM, Imola T, Voicu SL, Gliga MG, et al. Twinkle, twinkle little stone: an artifact improves the ultrasound performance! Medical Ultrasonography. 2017;19(3):272.
Mitterberger M, Aigner F, Pallwein L, Pinggera G-M, Neururer R, Rehder P, et al. Sonographic detection of renal and ureteral stones: value of the twinkling sign. International braz j urol. 2009;35(5):532-41.
Dillman JR, Kappil M, Weadock WJ, Rubin JM, Platt JF, DiPietro MA, et al. Sonographic Twinkling Artifact for Renal Calculus Detection: Correlation with CT. Radiology. 2011;259(3):911-6.
Sorensen MD, Harper JD, Hsi RS, Shah AR, Dighe MK, Carter SJ, et al. B-mode ultrasound versus color Doppler twinkling artifact in detecting kidney stones. J Endourol. 2013;27(2):149-53.
Winkel RR, Kalhauge A, Fredfeldt K-E. The Usefulness of Ultrasound Colour-Doppler Twinkling Artefact for Detecting Urolithiasis Compared with Low Dose Nonenhanced Computerized Tomography. Ultrasound in Medicine & Biology. 2012;38(7):1180-7.
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Copyright (c) 2025 Munazza Kainat Shuja, Ghazala Wahid, Faryal Bashir, Ayesha Jawaid , Shaista Khan, Ayesha Amjad
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