Occurrence of colour doppler twinkle artifact in renal calculi with and without posterior acoustic shadowing

Nephrolithiasis affects approximately 7-15% of the global population. Conventional B-Mode ultrasonography has limitations detecting small renal calculi (<5 mm) or calculi lacking a distinct posterior acoustic shadow, whereas the Colour Doppler twinkle artifact has been reported to improve detection sensitivity; however, its occurrence across B-Mode sonographic patterns of nephrolithiasis remains unclear. This research aimed to describe the sonographic patterns (SP) of renal calculi on B-Mode ultrasonography and the occurrence of the Colour Doppler twinkle artifact within each pattern. A quantitative descriptive observational design combined primary and secondary data from 40 renal ultrasound images of patients with nephrolithiasis, collected consecutively from October 2025 to May 2026 at Hospital X. Data were analysed descriptively, and twinkle artifact occurrence between SP1 and SP2 was compared using Fisher's Exact Test. All 40 samples showed hyperechoic echogenicity on B-Mode, evenly divided into SP1 (hyperechoic with posterior acoustic shadow, 20 samples) and SP2 (hyperechoic without shadow, 20 samples). The twinkle artifact was detected in 37 of 40 samples (92.5%): 90% in SP1 and 95% in SP2 (p = 1.000). Three negative cases (7.5%), with stone sizes of 0.3-0.6 cm, were likely related to stone size and mineral composition. The Colour Doppler twinkle artifact may be a complementary feature to B-Mode ultrasonography, particularly in SP2 lesions without acoustic shadowing, and should be interpreted alongside B-Mode findings and clinical presentation; studies with a reference standard are needed.