Twinkling Artifact of Microcalcifications in Breast Ultrasound

Abstract

In general, twinkling artifact (TWA) is recognized in color Doppler during abdominal ultrasongraphy such as gall stones, pancreatic stones and urolithiasis. In breast disease, TWA is only reported in a few cases with the apocrin cyst and with cholesterol granuloma. Recently, several cases were found in which TWA was observed when the color Doppler was applied to the microcalcifications of various breast diseases. Therefore, we examined the cases with TWA in microcalcifications of category 3 in mammography screening. In January 2016 - February 2017, we examined 44 cases of category 3 microcalcifications using color Doppler. Nine cases were biopsied, 7 benign lesions, 2 malignant lesions.We used Aplio 500 or 300 with 14L5 probe.With color Doppler, the speed range was set to MAX so that almost no blood flow information was found, and ROI was set widely so that the whole mammary gland was included. The area considered to be included microcalcifications was scanned to determine the presence or absence of TWA. In preliminary examinations of microcalcifications in breast diseases, we found TWA can be seen with MAX speed range and with wide ROI. The FFT analysis showed no wave curves of blood flow but only noises in TWA.Among 44 cases, TWA was seen in 28 cases, 63.6%.All nine cases biopsied were positive for TWA. If TWA is seen, it can be confirmed that echogenic foci are true calcifications.TWA can identify the site of micorcalcifications of category 3. And the core needle biopsy can be done under the color Doppler with TWA.Applications of TWA for microcalcifications in breast disease should be widely used.