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The effect of surface tension on the color Doppler ultrasound twinkling artifact

Imaging crystalline structures with Doppler ultrasound can produce a rapid color shift, termed the twinkling artifact, that can assist in diagnosing pathological mineralizations such as kidney stones, heterotopic ossification, gout, and breast microcalcifications. Twinkling is theorized to arise from scattering off surface crevice microbubbles, which are affected by the surface tension between the bubble and surrounding medium. In this study, we evaluated the effect of surface tension on twinkling in pure crystals. Cholesterol, calcium phosphate, and uric acid crystals were grown in vitro (n = 5 each) and imaged with a Philips/ATL L7-4 transducer and Vantage-128 research ultrasound system. Crystals were imaged in water while varying surfactant concentration (0%–4%) leading to surface tensions that ranged from 45–72 mN/m. Surface tension of the solution was determined by measuring the contact angle of 0.1-mL droplet on an acrylic sheet exposed to air. As the concentration of surfactant increased, twinkling was found to decrease by ∼20% for cholesterol and calcium phosphate and ∼10% for uric acid. These results continue to support the crevice bubble theory of twinkling and suggest the importance of surface tension when evaluating minerals with the twinkling artifact. [Work supported by NSF-CAREER-1943937 and NSF-GRFP-DGE1255832.]