Sonographic Twinkling Artifact in a Renal Graft With Prolene Mesh

Abstract

onography is a widely used modality for the evaluation of transplanted kidneys. It is portable, fast, and noninvasive, and the superficial location of the renal transplant in the iliac fossa is ideal for sonographic imaging. Sonography can be used to evaluate the renal parenchyma, collecting system, and peritransplant regions as well as to guide percutaneous drainage and biopsy procedures. Additionally, color Doppler sonography enhances the diagnostic capabilities of renal sonography and can be used to assess the transplant vasculature, which is critical in the evaluation of renal graft dysfunction. 1,2 Prolene mesh (Vicryl; Ethicon, Inc, Somerville, NJ) may be wrapped around a transplant kidney to prevent bleeding in cases of cortical tears, renal graft rupture, or lack of a capsule. 3 Importantly, the mesh will appear echogenic on sonography and can be easily mistaken for air around the capsule or perinephric fat. We present a case of renal graft evaluation using color Doppler sonography, which revealed a twinkling artifact caused by mesh surrounding the graft. To the best of our knowledge, this finding has not been previously reported in the literature.

Systematic Analysis of Factors Related to Display of the Twinkling Artifact by a Phantom

“…Recent studies have shown that the twinkling artifact has gained widespread application beyond renal stones to other entities with strong reflective surfaces, 8 , 9 including metallic foreign objects, 10 gallbladder adenomyomatosis, 11 intrauterine fetal death, 12 chronic pancreatitis, 13 and others. On the other hand, some researchers have stated that attention should be paid to identification and interpretation of the twinkling artifact so that it may be accurately distinguished from true blood flow 9 , 14 .…”

Noninvasive Prediction of Renal Stone Surface Irregularities by Numerical Analysis of the Color Doppler Twinkling Artifact: An Ex Vivo Study

“…Since its introduction in 1996, the diagnostic value of the twinkling artifact on color Doppler US has been investigated in the field of urology . This study was concerned with the noninvasive prediction of roughness levels of kidney stones with the use of quantitative analysis and measurement of their corresponding twinkling artifacts.…”

“…Since its introduction in 1996, the diagnostic value of the twinkling artifact on color Doppler US has been investigated in the field of urology. 10,36,[40][41][42][43][44][45][46][47][48] This study was concerned with the noninvasive prediction of roughness levels of kidney stones with the use of quantitative analysis and measurement of their corresponding twinkling artifacts. The clinical advantage is for the sake of the correlation between renal stone morphologic characteristics and their fragility, 49 which can determine the effectiveness of treatment.…”

Usefulness of the Twinkling Artifact in Identifying Implanted Mesh After Inguinal Hernia Repair

“…The cause is likely noise caused by phase (clock) jitter in the Doppler circuitry of the machine; a rough surface is thought to be secondary and broadens the spectrum 5 . Although this artifact may be found in different circumstances, 24 , 25 the irregular surface of mesh also produces it, and this artifact may be useful in identifying mesh when it is not appreciated on routine gray scale sonography. The bowel wall may also show twinkling (Figure 2) and is a pitfall when evaluating mesh adjacent to the bowel, which usually occurs cranial to the implant when evaluating inguinal hernia mesh repairs.…”