From the Guidelines
Yes, twinkling artifact on ultrasound can be associated with air. Twinkling artifact appears as a rapidly changing mixture of colors behind a strongly reflecting structure during color Doppler ultrasound examination. While this artifact is most commonly associated with calcifications or stones, it can also occur when air is present in tissues or cavities. Air bubbles or pockets create strong acoustic interfaces that scatter the ultrasound beam in multiple directions, producing the characteristic twinkling effect. This phenomenon occurs because air has a significantly different acoustic impedance compared to surrounding soft tissues, creating strong reflections and scattering of the ultrasound waves. Clinically, this is important to recognize as twinkling artifacts from air can be seen in various situations such as pneumobilia (air in bile ducts), emphysematous infections, post-procedural air introduction, or bowel gas. Radiologists and sonographers should be aware that not all twinkling artifacts indicate calcifications, and correlation with patient history and other imaging findings is essential for accurate interpretation, as noted in studies such as 1. Some studies have shown the effectiveness of ultrasound in detecting certain conditions, for example, a study from 1 showed that ultrasound had a high sensitivity and specificity for diagnosing pneumothorax. However, the specific topic of twinkling artifact associated with air is not directly addressed in the provided evidence, but based on the principles of ultrasound and the behavior of air in the body, it is reasonable to conclude that twinkling artifact can be associated with air. Key points to consider include:
- Twinkling artifact is not exclusive to calcifications or stones
- Air can produce a similar effect due to its acoustic properties
- Clinical context and correlation with other findings are crucial for accurate interpretation
- Ultrasound is a valuable tool in various medical applications, including the detection of pneumothorax, as shown in 1.
From the Research
Twinkling Artifact on Ultrasound
- The twinkling artifact (TA) is characterized by a rapidly changing mixture of red and blue color Doppler signals 2
- The source of the TA is not clearly understood yet, but it may provide additional information to gray-scale ultrasound findings in several clinical situations 2
Relation to Air
- There is no direct evidence in the provided studies that the twinkling artifact on ultrasound is caused by air
- However, studies have shown that Doppler sonography can be used to detect pneumothorax, which is the presence of air in the pleural space 3
- Color and power Doppler sonography may be used as an adjunct to B- and M-mode imaging for detection of pneumothorax, but its relation to the twinkling artifact is not explicitly stated 3
Clinical Applications
- The twinkling artifact has been used to detect microcalcifications in breast tissue, and its presence can increase the yield of ultrasound-guided biopsies 4
- The TA may be useful in other clinical applications, but its relation to air is not well established in the provided studies
- Pneumoperitoneum, which is the presence of air in the abdominal cavity, has a wide differential diagnosis and presents with varying degrees of severity 5, 6