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Wood BG, Saracaydin R, Hara SA, Lee CU, Urban MW. Using 3-D-Printed Structures to Evaluate the Potential Causes of the Color Doppler Twinkling Signature. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:671-679. [PMID: 38331697 PMCID: PMC10977030 DOI: 10.1016/j.ultrasmedbio.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation occurring on rough objects such as kidney stones, some breast biopsy clips, catheter guidewires and sandpaper. The objective was to investigate the correlation between the surface characteristics of helical constructs with different groove geometries and the occurrence of twinkling, as well as to identify locations conducive to bubble retention and/or cavitation. METHODS Six half-cylinders were created with a microscale 3-D printer with 5 µm resolution to replicate the geometry of twinkling helical constructs resembling catheter guidewires. Four copies of each marker including a non-twinkling control were printed. The half-cylinders had pitch (peak-to-peak distance) values ranging from 87.5 to 343 µm and amplitude (groove depth) values ranging from 41.5 to 209 µm. The half-cylinders were submerged in degassed water and optically imaged before and after ultrasound insonification to visualize bubbles on the cylinders. The cylinders remained submerged while scanning with the color Doppler mode at frequencies from 3.1 to 6.3 MHz using a GE Logiq E9 scanner and 9L linear array transducer. RESULTS Two markers exhibited twinkling: one with pitch-to-amplitude ratio of 174/210 µm/µm (0.8) that twinkled only with pre-existing bubbles on the marker; the other had a ratio of 87/87 µm/µm (1.00) that twinkled without pre-existing bubbles on the marker. CONCLUSION This work provides strong evidence that both existing bubbles and either cavitation or ultrasound wave interactions with patterned or rough surfaces are significant factors in producing the twinkling signature.
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Affiliation(s)
- Benjamin G Wood
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA.
| | | | - Seth A Hara
- Division of Engineering, Mayo Clinic, Rochester, MN, USA
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Abstract
Chronic pancreatitis is a clinical entity that results from the progressive inflammation and irreversible fibrosis of the pancreas resulting from the cumulative injury sustained by the pancreas over time. It is an illness with variable presentations that can severely impact quality of life, while its long-term complications such as exocrine pancreatic insufficiency (EPI), diabetes mellitus, and risk of pancreatic cancer can become life threatening. The diagnosis of chronic pancreatitis can be challenging as despite the recent advancements in imaging technology, the radiographic findings do not become prominent until late stages of disease. Thus, the physicians' clinical acumen in obtaining thorough history taking focusing on risk factors, clinical symptoms, in addition to high-quality imaging, often guide to the accurate diagnosis of chronic pancreatitis. Endoscopy also plays a pivotal role in the diagnosis and management of chronic pancreatitis. Endoscopic ultrasound (EUS) is believed to be the most sensitive modality for diagnosing chronic pancreatitis. Despite efforts, however, natural history studies have demonstrated that 61% of individuals with chronic pancreatitis will require at least one endoscopic intervention, while 31% will require a surgical procedure as part of their management strategy. Recent advancements in genomic studies have furthered our understanding of the genetic polymorphisms that are associated with the pathogenesis of chronic pancreatitis. Genetic testing offers the potential to reveal treatable pancreatitis-related disorders, and can inform decision making with regard to radical therapies for persistent or severe disease such as total pancreatectomy with islet autotransplantation (TPIAT). The management of patients suffering from chronic pancreatitis often requires a multi-disciplinary approach, addressing pertinent symptoms as well as the sequelae of chronic inflammation and fibrosis. Abdominal pain is the prevailing symptom and most common complication of chronic pancreatitis, and impairs quality of life. Although heavily dependent on a wide range of analgesia, endoscopic treatment such as endoscopic retrograde cholangiopancreatography (ERCP) and surgical intervention can offer long-lasting relief of symptoms. For EPI, treatment with pancreatic enzyme supplements offers marginal-to-moderate relief. The most feared complication of chronic pancreatitis-the development of pancreatic cancer-has no known prevention measure to date.
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Wu SP, Huang YJ, Tsao TF, Tyan YS, Su CH. An In vitro Study of Guidewire-Related Color Doppler Twinkling Artifacts in Echocardiography. J Med Ultrasound 2019; 26:200-204. [PMID: 30662151 PMCID: PMC6314096 DOI: 10.4103/jmu.jmu_23_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/29/2018] [Indexed: 11/05/2022] Open
Abstract
Purpose: This study sought to determine the association between twinkling artifacts on color Doppler ultrasound and different types of guidewires. Materials and Methods: Twenty-two commonly used guidewires were classified into three groups according to decreasing diameter (Group 1, 0.035”; Group 2, 0.018”; and Group 3, 0.014”) and tested in vitro. Severity of twinkling was visually graded into four categories (0–3, from weak to strong). Results: The percentages (tips/shafts) of twinkling artifacts were 100%/100% for Group 1; 0%/33.3% for Group 2; and 18.8%/31% for Group 3. The mean scores (tips/shafts) were 2.3/2.7 for Group 1; 0/0.3 for Group 2; and 0.3/0.4 for Group 3. Among them, both two guidewires with strong twinkling artifacts (score = 3) exhibited extensive rough surfaces on microscopic pictures. Conclusion: The twinkling artifacts were more likely to present in guidewires with larger diameters (from 0.014” to 0.035”) in our study settings. The surface roughness may be the contribution to the twinkling artifact. Internal heterogeneities, such as types of material, types of coating, tip loading, and spring coil length, do not show influence on the twinkling artifact.
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Affiliation(s)
- Shu-Ping Wu
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung City, Taiwan
| | - Yi-Jui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung City, Taiwan
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung City, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan.,Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung City, Taiwan
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical, University Hospital, Taichung City, Taiwan
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Bacha R, Gilani SA, Manzoor I. Relation of Color Doppler Twinkling Artifact and Scale or Pulse Repetition Frequency. J Med Ultrasound 2019; 27:13-18. [PMID: 31031530 PMCID: PMC6445033 DOI: 10.4103/jmu.jmu_129_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the effect of scale/pulse repetition frequency (PRF) on the appearance of color Doppler twinkling artifact. MATERIALS AND METHODS We commenced this cross-sectional study for 20 months from November 2014 to July 2016. During routine ultrasound examination, we observed multiple case of twinkling artifact produced by renal stones, calcifications in the thyroid nodules, bony fragments and intestinal gases, etc., We observed twinkling artifact with low- and high-PRF settings in 500 different structures. A total of 500 other structures were included wherein there was no Doppler twinkling artifact produced by them, with usual optimum PRF settings. These structures were also evaluated with low- and high-PRF to determine the effect of PRF on twinkling artifact effectively. All the patients were examined according to the AIUM guideline for appropriate examination protocol. Data were collected from the observation of twinkling artifact with low- and high-PRF/scale and evaluated with the help of IBM SPSS 24 package, the results were summarized as follow. RESULTS Change in scale/PRF could not affect the twinkling artifact. The twinkling artifact observed with low-PRF was the same as seen with high-PRF. There was a significant agreement between low- and high-PRF in the production of color twinkling artifact. The kappa value of agreement was estimated as 0.96, whereas the Pearson's correlation was significant with the value of 0.001. Same twinkling artifact was created with low- and high-PRF, with no significant variation. CONCLUSION Twinkling artifact is independent of PRF/Scale.
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Affiliation(s)
- Raham Bacha
- Department of University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), Faculty of Allied Health Sciences (FAHS), University of Lahore, Pakistan
- Gilani Ultrasound Center, Afro-Asian Institute, Lahore, Pakistan
| | - Syed Amir Gilani
- Department of University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), Faculty of Allied Health Sciences (FAHS), University of Lahore, Pakistan
- Gilani Ultrasound Center, Afro-Asian Institute, Lahore, Pakistan
| | - Iqra Manzoor
- Department of University Institute of Radiological Sciences and Medical Imaging Technologies (UIRSMIT), Faculty of Allied Health Sciences (FAHS), University of Lahore, Pakistan
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Tian J, Xu L. Color Doppler Twinkling Artifact in Diagnosis of Tuberculous Pleuritis: A Comparison with Gray-Scale Ultrasonography and Computed Tomography. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1291-1295. [PMID: 29549975 DOI: 10.1016/j.ultrasmedbio.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to determine whether twinkling artifact (TA) detected on color Doppler ultrasonography can effectively determine the presence of pleural calcification compared with computed tomography (CT) and differentiate tuberculous pleuritis (TP) and cancerous pleuritis (CP). One hundred six cases of TP and 26 cases of CP were scanned using gray-scale ultrasonography (GSU) and TA to determine the presence of pleural calcification. With CT as the reference standard, 63.3% and 79.6% of patients with pleural calcification were identified with GSU and TA, respectively. The detection rate of TA was higher than that of GSU (p = 0.039). For the whole study population, 37.1% were identified as having pleural calcification with CT, significantly higher than the proportion detected with GSU (25.8%, p = 0.001), but not different from that detected with TA (41.7%, p = 0.327). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TA were 79.6%, 80.7%, 80.3%, 70.9% and 87.0%, respectively. The detection rate of TA was significantly higher than that of GSU (p <0.001). When GSU was combined with TA (GSUTA), the positive rate in the TP group was significantly higher than that in the CP group (χ2 < 0.001). In conclusion, TA is comparable to CT and more sensitive than GSU in the detection of pleural calcification. Evaluation for GSUTA on pleura may help to differentiate TP from CP.
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Affiliation(s)
- Jiakai Tian
- Department of Special Examination, Shandong Provincial Chest Hospital, Shandong, China
| | - Liang Xu
- Department of Radiology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Shandong, China.
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Choi MJ, Cho CH, Kang G, Yang J. Color Doppler twinkling artifact: Possible mechanisms and clinical potential. Biomed Eng Lett 2014. [DOI: 10.1007/s13534-014-0124-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jamzad A, Setarehdan SK. A novel approach for quantification and analysis of the color Doppler twinkling artifact with application in noninvasive surface roughness characterization: an in vitro phantom study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:597-610. [PMID: 24658939 DOI: 10.7863/ultra.33.4.597] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The twinkling artifact is an undesired phenomenon within color Doppler sonograms that usually appears at the site of internal calcifications. Since the appearance of the twinkling artifact is correlated with the roughness of the calculi, noninvasive roughness estimation of the internal stones may be considered as a potential twinkling artifact application. This article proposes a novel quantitative approach for measurement and analysis of twinkling artifact data for roughness estimation. METHODS A phantom was developed with 7 quantified levels of roughness. The Doppler system was initially calibrated by the proposed procedure to facilitate the analysis. A total of 1050 twinkling artifact images were acquired from the phantom, and 32 novel numerical measures were introduced and computed for each image. The measures were then ranked on the basis of roughness quantification ability using different methods. The performance of the proposed twinkling artifact-based surface roughness quantification method was finally investigated for different combinations of features and classifiers. RESULTS Eleven features were shown to be the most efficient numerical twinkling artifact measures in roughness characterization. The linear classifier outperformed other methods for twinkling artifact classification. The pixel count measures produced better results among the other categories. The sequential selection method showed higher accuracy than other individual rankings. The best roughness recognition average accuracy of 98.33% was obtained by the first 5 principle components and the linear classifier. CONCLUSIONS The proposed twinkling artifact analysis method could recognize the phantom surface roughness with average accuracy of 98.33%. This method may also be applicable for noninvasive calculi characterization in treatment management.
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Affiliation(s)
- Amoon Jamzad
- Control and Intelligent Processing Center of Excellence, School of Electrical and Computer Engineering, College of Engineering, University of Tehran, North Kargar Street, Tehran 14395-515, Iran.
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Yu MH, Lee JY, Yoon JH, Baek JH, Han JK, Choi BI. Color Doppler twinkling artifacts from gallbladder adenomyomatosis with 1.8 MHz and 4.0 MHz color Doppler frequencies. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1188-1194. [PMID: 22579538 DOI: 10.1016/j.ultrasmedbio.2012.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 03/09/2012] [Accepted: 03/12/2012] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to investigate the diagnostic value of color Doppler twinkling artifacts (CDTAs) in the evaluation of gallbladder adenomyomatosis with differently colored Doppler frequencies. An ultrasound was performed by an experienced radiologist in 17 patients with typical gallbladder adenomyomatosis. Two abdominal radiologists retrospectively evaluated the anatomic locations, the intensity of 69 CDTAs on 1.8 MHz and 4.0 MHz Doppler frequencies, and the intensity of the corresponding comet-tail artifacts. Statistical analysis was performed using the Friedman and Kruskal-Wallis test. The intensity of the CDTAs was significantly greater than that of the comet-tail artifacts, regardless of the color Doppler frequency and anatomic location (p < 0.001). The intensity of the CDTAs on 1.8 MHz was significantly higher than that on 4.0 MHz color Doppler frequency (p < 0.05). In conclusion, CDTAs may be useful in recognizing gallbladder adenomyomatosis, and 1.8 MHz color Doppler frequency is more highly recommended than 4.0 MHz for the visualization of CDTAs.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
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Wang M, Li J, Xiao J, Shi D, Zhang K. Systematic analysis of factors related to display of the twinkling artifact by a phantom: an optimized investigation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1449-1457. [PMID: 22039017 DOI: 10.7863/jum.2011.30.11.1449] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze factors related to display of the twinkling artifact by a phantom. METHODS An in vitro phantom made of sandpaper was designed to mimic rough physiologic surfaces prone to generating the twinkling artifact. Sandpaper strips embedded in a plastic box were scanned through a water path under different machine settings with only 1 parameter varied each time. After choosing the best settings for displaying the twinkling artifact, 4 types of sandpaper with different roughness were scanned. The resulting images were recorded at random, and the number of color pixels in the color box of each image was calculated by a custom-designed program developed using commercially available software. All data were then evaluated by regression analysis, a paired 2-tailed Student t test, and single-factor analysis of variance. RESULTS The highest color write priority and color gain, which were just below the threshold for color noise, a focus depth setting below the sandpaper, a maximum wall filter under a higher pulse repetition frequency, and a color box adjusted properly in the fundamental imaging mode (P < .001) were found to most readily improve the twinkling artifact intensity. The roughness of the sandpaper was shown to be highly correlated with the twinkling artifact intensity (R(2) = 0.832; P < .001). CONCLUSIONS The twinkling artifact was influenced by some machine parameters and the roughness of the sandpaper. By adjusting some ultrasound machine parameters, a better image reflecting the twinkling artifact can be shown in clinical practice and research.
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Affiliation(s)
- Meng Wang
- Department of Ultrasound, Qilu Hospital, Shandong University, 107 Wenhuaxi Rd, 250012 Jinan, Shandong, China
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10
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Tsao TF, Wu YL, Yu JM, Kang RJ, Tseng YH, Huang HH, Hung SW, Gueng MK, Lin YC, Tyan YS, Su CH. Color Doppler twinkling artifact of calcified cardiac valves in vitro: a not well known phenomenon in echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:386-392. [PMID: 21256665 DOI: 10.1016/j.ultrasmedbio.2010.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/25/2010] [Accepted: 12/03/2010] [Indexed: 05/30/2023]
Abstract
The color Doppler twinkling artifact manifests as a rapidly changing mixture of red and blue colors behind strongly reflective structures. The twinkling artifact occurs behind diseased cardiac valves, although the phenomenon is not well described. This study sought to determine the presence of the color Doppler twinkling artifact in calcified cardiac valves in vitro using soft tissue radiography for reference. Seventeen specimens of diseased cardiac valves from patients undergoing valve replacement surgery were studied. The overall sensitivity and specificity for the detection of calcifications using the presence of the twinkling artifact were 66.7% and 81.8%, respectively. If valves with only microcalcifications or smooth calcifications were eliminated from the analysis, all (100%) of the three valves with irregular macrocalcifications exhibited the twinkling artifact. It is important to recognize this artifact because it may lead to misdiagnosis of vascular flow in echocardiography.
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Affiliation(s)
- Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung City, Taiwan
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Kim HJ, Lee JY, Jang JY, Kim SJ, Kim SH, Han JK, Choi BI. Color Doppler twinkling artifacts from gallstones: in vitro analysis regarding their compositions and architectures. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:2117-2122. [PMID: 20950930 DOI: 10.1016/j.ultrasmedbio.2010.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 08/08/2010] [Accepted: 08/30/2010] [Indexed: 05/30/2023]
Abstract
The purpose of our study was to investigate the relationship between a twinkling artifact and the biochemical compositions of gallstones in phantom experiments. Fifty-two gallstones surgically extracted from 26 patients (26 cholesterol, 12 brown pigment and 14 black pigment stones) were included in the phantom study. Color Doppler sonography was performed to evaluate the occurrence of a twinkling artifact behind the stones. The artifacts were graded from grade 0 (no artifact) to grade 3 (very strong artifact). Micro computed tomography (CT) images were obtained to analyze the internal architecture and external surface of the stones. A total of 20 of 26 cholesterol stones (77%) produced grade 2 or 3 artifacts, whereas almost all the black pigment stones and more than half of the brown pigment stones produced no artifacts or grade 1 artifacts (p = 0.0010). The sensitivity and specificity of grade 2 or greater artifacts for cholesterol stones were 76.9% and 76.9%, respectively. The composition of the stones was strongly correlated with the internal shape on the micro CT image. Cholesterol stones with rough surfaces did not show stronger intensities of the artifacts than those with smooth surfaces (p > 0.05). In conclusion, most of the prominent artifacts arose from cholesterol stones having radial or radial-concentric internal architectures, whereas the black pigment stones mostly produced little artifact.
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Affiliation(s)
- Hyuk Jung Kim
- Department of Radiology, Seoul Medical Center, Seoul, Korea
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Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, Uomo G, Andriulli A, Balzano G, Benini L, Calculli L, Campra D, Capurso G, Cavestro GM, De Angelis C, Ghezzo L, Manfredi R, Malesci A, Mariani A, Mutignani M, Ventrucci M, Zamboni G, Amodio A, Vantini I, Bassi C, Delle Fave G, Frulloni L, Vantini I, Falconi M, Frulloni L, Gabbrielli A, Graziani R, Pezzilli R, Capurso IV, Cavestro GM, De Angelis C, Falconi M, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Manfredi R, Malesci A, Mariani A, Mutignani M, Pezzilli R, Uomo G, Ventrucci M, Zamboni G, Vantini I, Magarini F, Albarello L, Alfieri S, Amodio A, Andriulli A, Anti M, Arcidiacono P, Baiocchi L, Balzano G, Benini L, Berretti D, Boraschi P, Buscarini E, Calculli L, Carroccio A, Campra D, Celebrano MR, Capurso G, Casadei R, Cavestro GM, Chilovi F, Conigliaro R, Dall'Oglio L, De Angelis C, De Boni M, De Pretis G, Di Priolo S, Di Sebastiano PL, Doglietto GB, Falconi M, Filauro M, Frieri G, Frulloni L, Fuini A, Gaia E, Ghezzo L, Gabbrielli A, Graziani R, Loriga P, Macarri G, Manes G, Manfredi R, Malesci A, Mariani A, Massucco P, Milani S, Mutignani M, Pasquali C, Pederzoli P, Pezzilli R, Pietrangeli M, Rocca R, Russello D, Siquini W, Traina M, Uomo G, Veneroni L, Ventrucci M, Zilli M, Zamboni G. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis 2010; 42 Suppl 6:S381-406. [PMID: 21078490 DOI: 10.1016/s1590-8658(10)60682-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery.
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Affiliation(s)
- Luca Frulloni
- Department of Medicine, University of Verona, Verona, Italy.
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Zhao BW, Yang Y, Pan M, Li P, Wang B, Tang FG. Color Doppler twinkling artifact in fetuses with echogenic intracardiac foci: echocardiographic observation and clinical significance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:548-551. [PMID: 20336698 DOI: 10.1002/uog.7641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate echocardiographic characteristics and clinical relevance of color Doppler twinkling artifacts in fetuses with isolated echogenic intracardiac foci (EIF). METHODS This study included 50 fetuses with EIF, at 18-38 weeks of gestation. Echocardiographic examination, which was performed using a 1.0-5.0-MHz phased array probe, included gray-scale, color and spectral Doppler imaging. Twinkling artifacts were assessed using fetal color Doppler echocardiography on isolated EIF situated in the left and/or right ventricles. The prevalence, appearance and clinical relevance of the color Doppler twinkling artifacts were analyzed. RESULTS Eight of 50 fetuses with EIF (16%) showed color Doppler twinkling artifacts, which appeared as a rapidly changing color complex seen persistently behind the EIF. The spectra obtained in all eight with color Doppler artifacts were composed of straight vertical bands occurring in mid to late systole and early diastole. After birth, none of 50 fetuses with EIF had structural heart diseases or showed clinical signs of cardiac failure. CONCLUSIONS Color Doppler twinkling artifacts from isolated EIF occur in some fetuses and may be considered as an additional echocardiographic feature of EIF. Attention should be paid to the identification and interpretation of these artifacts so that they may be accurately distinguished from true color flow generated by atrioventricular valvular regurgitation jets.
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Affiliation(s)
- B W Zhao
- Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University Medical College, Hangzhou, China.
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Hassani H, Brasseur A, Raynal G, Texier A, Demuynck F, Bismuth G, Saidi L. [Twinkling artifact on Doppler US: clinical presentations]. JOURNAL DE RADIOLOGIE 2010; 91:539-542. [PMID: 20657351 DOI: 10.1016/s0221-0363(10)70084-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Twinkling artifact characterized by a rapidly fluctuating mixture of Doppler signals occurs behind a strongly reflecting granular interface such as urinary tract stones or gallstones. It may occurs in association with several clinical situations, and may sometimes be helpful for diagnosis while it may sometimes be a pitfall that must be recognized by the sonographer. After reviewing the technical nature of this artifact, several cases will be presented to illustrate the advantages and pitfalls related to this artifact.
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Affiliation(s)
- H Hassani
- Radiologie et Imagerie médicale, CHU d'Amiens, place Victor Pauchet, 80054 Amiens cedex 1.
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Kim HC, Yang DM, Jin W, Ryu JK, Shin HC. Color Doppler twinkling artifacts in various conditions during abdominal and pelvic sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:621-632. [PMID: 20375381 DOI: 10.7863/jum.2010.29.4.621] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aims of this study were to describe the mechanisms likely to be responsible for color Doppler twinkling artifacts and their associated machine factors and to illustrate the various conditions that cause twinkling artifacts and those pitfalls. METHODS We evaluated various sonographic machine-associated factors that influence artifact appearance and identified various conditions that display twinkling artifacts during abdominal and pelvic sonography. RESULTS The presence of twinkling artifacts was found to be dependent on focal zones, gray scale gains, color write priorities, and pulse repetition frequencies. Twinkling artifacts were found to be associated with calcified lesions in the liver, gallbladder adenomyomatosis, hepatic bile duct hamartoma, gallstones and choledocholithiasis, chronic pancreatitis, urinary stones, encrusted indwelling urinary stents, bowel gas, and metallic foreign bodies. However, some of the twinkling artifacts were found to be associated with false-negative and -positive results. CONCLUSIONS Color Doppler twinkling artifacts are additional useful sonographic signs in the diagnosis of calcified lesions, urinary and biliary stones, gallbladder adenomyomatosis, and some miscellaneous conditions.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, East-West Neo Medical Center, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Korea.
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Tsao TF, Kang RJ, Gueng MK, Tyan YS, Lin YC, Lee SK. Color Doppler Twinkling Artifact and Clinical Use. J Med Ultrasound 2009. [DOI: 10.1016/s0929-6441(09)60122-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ozkur A, Dikensoy E, Kervancioglu S, Kervancioglu R, Inalöz S, Bayram M. Color Doppler twinkling artifact in intrauterine fetal demise. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:153-6. [PMID: 17565755 DOI: 10.1002/jcu.20381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To determine whether twinkling artifacts on color and power Doppler sonography could be used as a new sonographic sign of intrauterine fetal demise (IUFD). METHODS In this prospective study, 24 consecutive pregnant women with IUFD were included after fetal sonographic examinations. Sonographic examination included gray-scale, color, power, and spectral Doppler imaging. The sonograms were then analyzed for the presence, appearance, and intensity of the twinkling artifacts. RESULTS Twinkling artifacts on color Doppler were observed in all of the 24 IUFD as a rapidly changing color Doppler signal complex associated persistently with different parts of the fetal body. The artifacts were localized especially in the neck, back, and iliac regions. Artifact intensity correlated with the time elapsed since death. CONCLUSION Twinkling artifact was noted in all dead fetuses on color, power, and spectral Doppler examinations. Thus, the observation of these artifacts may be considered as a new sonographic sign of fetal demise, which may reflect the time elapsed since death.
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Affiliation(s)
- Ayhan Ozkur
- Department of Radiology, School of Medicine, Gaziantep University, 27310 Gaziantep, Turkey
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