Twinkle artifact in breast US

[Breanna Welsh]

Hello Stephen,

What is your opinion regarding twinkle artifact as a useful technique for detecting breast microcalc, clips etc. Do you ever find it helps? Also, do you ever note twinkle artifact within fibrocystic breast lesions? Thanks.

[Stephen Bird]

Hi Breanna,

I like the way you are thinking here.

Personally I have not found twinkle artifact very helpful.
I think it is due to the fact that the calcs associated with DCIS are so tiny that they don’t generate the artifact readily. But I think this is worth investigating further and perhaps with the correct frequency and PRF settings we can generate a twinkle response which could potentially be very helpful as identifying DCIS microcalcs is very difficult.
I have not tried to use it for clips, but it is a good idea. I often find it difficult to identify a clip and like any other foreign body localisation attempt it is always the angle you are hitting the clip at that makes it either easy to see or invisible. So like looking for a foreign body I first localise the expected location using the mammo and then investigate that part of the breast from many different angles until I find the clip. I will in the future try and use twinkle artifact, however the clip is metallic rather than crystalline so I wonder if it will produce the artifact.

Certainly in fibrocystic disease you do get some crystal formation ion the wall of the cyst which may produce the artifact, however the presence or absence of twinkle wouldn’t really change how I think about the lesion.

Steve

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