The usefulness of ultrasound colour-Doppler twinkling artefact for detecting urolithiasis compared with low dose nonenhanced computerized tomography

This prospective study evaluates the usefulness of the twinkling artefact (TA) seen on colour-Doppler ultrasound (US) in diagnosing urolithiasis. US and standard computed tomography (CT) were performed blinded on 105 patients. B-mode US and colour-Doppler used separately and in combination showed 55% sensitivity and 99% specificity (positive predictive value [PPV] 67% and negative predictive value [NPV] 98%). Of CT verified stones, 61% were ≤3 mm. TAs were present in 74% of the B-mode stones (43% of all CT verified stones). Patients with CT verified stone disease had significantly more TAs in other foci than the stone(s) found on CT, suggestive of microlithiasis. In conclusion, colour-Doppler TA is a helpful supplement for detecting urolithiasis when CT is contraindicated. In addition, US can be valuable in monitoring stones left to pass without intervention if they have presented a TA. CT, US and US with colour-Doppler TA can be useful as complementary techniques for detecting stones.