Twinling artefact : pourquoi est-il présent ou absent en arrière d ‘un calcul ?

AJR Am J Roentgenol. 1998 Oct;171(4):1055-60.

Characterization of urinary calculi: in vitro study of “twinkling artifact” revealed by color-flow sonography

Conclusion N°1

Le twinkling serait directement lié à la surface irrégulière d’un calcul.
Les calculs de monohydrate d’oxalate de calcium sont durs , lisses et ne présentent pas ou peu de twinkling.
Les calculs dihydrate d’oxalate de calcium et de phosphate de calcium présentent toujours un artefact de grade 1 ou 2
Conclusion N°2
calcul dur (surface lisse) : pas de twinkling
calcul fragile (surface irrégulière) ; twinkling

AJR Am J Roentgenol. 1998 Oct;171(4):1055-60.

Characterization of urinary calculi: in vitro study of “twinkling artifact” revealed by color-flow sonography.



The “twinkling artifact” is a color-flow sonographic artifact described behind calcifications and presenting as a random color encoding in the region where shadowing would be expected on gray-scale images. Our purpose was to study the relationship between this twinkling artifact seen behind urinary stones on color-flow sonography and the morphology or biochemical composition of these urinary stones.


Forty-seven urinary stones were studied in vitro with color-flow sonography. Transmit frequency, color gain, velocity range, color filters, focal depth, and depth of field were changed during scanning. The twinkling artifact was graded 0 when absent, 1 when present but occupying a portion of acoustic shadowing, and 2 when occupying the entire acoustic shadowing. Stones were studied under a binocular magnifying glass to characterize the surface, and infrared spectrophotometry was used to determine the chemical composition.


Calculi of calcium oxalate dihydrate and calcium phosphate always produced a grade 1 or grade 2 twinkling artifact. Absence of artifact was noted only for calcium oxalate monohydrate and urate stones. In 100% of grade 0 calcium oxalate stones, the monohydrate compound was predominant (>93%). In 100% of grade 2 calcium oxalate stones, the dihydrate compound was predominant (>75%). For calcium oxalate stones, the surface pattern was correlated with their composition. Sensitivity and specificity for absence of artifact, as indicative of calcium oxalate monohydrate, were 60% and 83%, respectively, for all stones and 56% and 100%, respectively, only for radiopaque stones.


An in vitro relationship exists between the twinkling artifact and the morphology of urinary stones. Color-flow sonography could play a role in detecting dense calcium oxalate monohydrate calculi, which in turn may help predict fragmentability.

[PubMed – indexed for MEDLINE]

Catégories :Urologie

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