Journal of Medical Ultrasonics

, Volume 40, Issue 3, pp 197–203 | Cite as

In vitro study of ultrasound radiation force-driven twinkling sign using PVA-H gel and glass beads tissue-mimicking phantom

  • Lei LiuEmail author
  • Kenichi Funamoto
  • Kei Ozawa
  • Makoto Ohta
  • Toshiyuki Hayase
  • Masafumi Ogasawara
Technical Note


The twinkling sign observed in ultrasound coded-excitation imaging (e.g., GE B-Flow) has been reported in previous research as a potential phenomenon to detect micro calcification in soft tissue. However, the mechanism of the twinkling sign has not been clearly understood yet. We conducted an in vitro experiment to clarify the mechanism of the twinkling sign by measuring a soft tissue-mimicking phantom with ultrasonic and optical devices. A soft tissue-mimicking phantom was made of poly(vinyl alcohol) hydro (PVA-H) gel and 200-μm-diameter glass beads. We applied ultrasound to the phantom using medical ultrasound diagnostic equipment to observe the twinkling sign of glass beads. Optical imaging with a laser sheet and a high-speed camera was performed to capture the scatter lights of the glass beads with and without ultrasound radiation. The scatter lights from the glass beads were quantified and analyzed to evaluate their oscillations driven by the ultrasound radiation force. The twinkling sign from the glass beads embedded in the PVA-H gel soft tissue phantom was observed in ultrasound B-Flow color imaging. The intensity and oscillation of the scattered lights from the glass beads showed significant difference between the cases with and without ultrasound radiation. The results showed a close relationship between the occurrence of the twinkling sign and the variations of the scatter lights of glass beads, indicating that ultrasound radiation force-driven micro oscillation causes the twinkling sign of micro calcification in soft tissue.


Twinkling sign Micro calcification Breast cancer Tissue-mimicking phantom Poly(vinyl alcohol) hydro gel Coded-excitation (B-Flow) 



Part of this work was carried out under the Collaborative Research Project of the Institute of Fluid Science, Tohoku University.

Conflict of interest

The authors have declared no conflict of interest.

Supplementary material

Supplementary material 1 (WMV 398 kb)


  1. 1.
    Morgan PM, Cooke MM, McCarthy MG. Microcalcifications associated with breast cancer: an epiphenomenon or biologically significant feature of selected tumors? J Mammary Gland Biol Neoplasia. 2005;10:181–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Frates CM, Benson BC, Charboneau JW, Cibas SE, Clark HO, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2005;237:794–800.PubMedCrossRefGoogle Scholar
  3. 3.
    Stoupis C, Taylor MH, Paley RM, Buetow CP, Marre S, et al. Rocky liver: radiologic–pathologic correlation of calcified hepatic masses. RadioGraphics. 1998;18:675–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Chelfouh N, Grenier N, Higueret D, Trillaud H, Levantal O, Pariente JL, Ballanger P. Characterization of urinary calculi: in vitro study of “twinkling artifact” revealed by color-flow sonography. Am J Roentgenol. 1998;171:1055–60.CrossRefGoogle Scholar
  5. 5.
    Lee JY, Kim SH, Cho JY, Han D. Color and power Doppler twinkling artifacts from urinary stones: clinical observations and phantom studies. Am J Roentgenol. 2011;176:1441–5.CrossRefGoogle Scholar
  6. 6.
    Rahmouni A, Bargoin R, Herment A, Bargoin N, Vasile N. Color Doppler twinkling artifact in hyperechoic regions. Radiology. 1996;199:269–71.PubMedGoogle Scholar
  7. 7.
    Yanik B, Conkbayir I, Çakmakçi E, Hekįmoğlu B. Color Doppler twinkling artifact in a calcified liver mass. J Clin Ultrasound. 2005;33:474–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim HC, Yang DM, Jin W, Ryu JK, Shin HC. Color Doppler twinkling artifacts in various conditions during abdominal and pelvic sonography. J Ultrasound Med. 2010;29:621–32.PubMedGoogle Scholar
  9. 9.
    Kamaya A, Tuthill T, Rubin MJ. Twinkling artifact on color Doppler sonography: dependence on machine parameters and underlying cause. Am J Roentgenol. 2003;180:215–22.CrossRefGoogle Scholar
  10. 10.
    Wang M, Li J, Xiao J, Shi D, Zhang K. Systematic analysis of factors related to display of the twinkling artifact by a phantom. J Ultrasound Med. 2011;30:1449–57.PubMedGoogle Scholar
  11. 11.
    Trillaud H, Pariente JL, Rabie A, Grenier N. Detection of encrusted indwelling ureteral stents using a twinkling artifact revealed on color Doppler sonography. Am J Roentgenol. 2001;176:1446–8.CrossRefGoogle Scholar
  12. 12.
    Mitchell C, Pozniak MA, Zagzebski J, Ledwidge M. Twinkling artifact related to intravesicular suture. J Ultrasound Med. 2003;22:1409–11.PubMedGoogle Scholar
  13. 13.
    Luca B, Antonio R, Sergio I, Giuseppina N, Stefano F, Bernadette B, Gianfranco V, Antonio S. A new marker for diagnosis of thyroid papillary cancer. J Ultrasound Med. 2008;27:1187–94.Google Scholar
  14. 14.
    Chiao YR, Mo YL, Hall LA, Miller CS, Thomenius EK. B-mode blood flow (B-Flow) imaging. Proc IEEE Ultrasonic Symp. 2000;2:1469–72.Google Scholar
  15. 15.
    Jamzad A, Setarehdan SK. Simulation of the twinkling artifact in color flow doppler sonography: a phase noise hypothesis validation. In: IEEE international conference on signal and image processing applications (ICSIPA2011). 2011; 22–27.Google Scholar
  16. 16.
    Behnam H, Hajjam A, Rakhshan H. Modeling twinkling artifact in sonography. In: Proceedings of IEEE ICBBE. 2010; ID 40082.Google Scholar
  17. 17.
    Matthew WU, Ivan ZN, Scott AM, Shigao C, James FG. Generalized response of a sphere embedded in a viscoelastic medium excited by an ultrasonic radiation force. J Acoust Soc Am. 2011;130:1133–41.CrossRefGoogle Scholar
  18. 18.
    Mostafa F, James FG. Vibro-acoustography: an imaging modality based on ultrasound-stimulated acoustic emission. Proc Natl Acad Sci. 1999;96:6603–8.CrossRefGoogle Scholar
  19. 19.
    Ohta M, Honda A, Iwata H, Rüfenacht AD, Tsutsumi S. Poly-vinyl alcohol hydrogel vascular models for in vitro aneurysm simulations: the key to low friction surfaces. Technol Health Care. 2004;12:225–33.PubMedGoogle Scholar
  20. 20.
    Kosukegawa H, Mamada H, Kuroki K, Liu L, Inoue K, Hayase T, Ohta M. Measurement of dynamic viscoelasticity of poly(vinyl alcohol) hydrogel for the development of blood vessel biomodeling. J Fluid Sci Technol. 2008;3:533–43.CrossRefGoogle Scholar
  21. 21.
    Liu L, Kosukegawa H, Ohta M, Hayase T. Anisotropic in vitro vessel model using poly(vinyl alcohol) hydro gel and mesh material. J Appl Polym Sci. 2010;116:2242–50.CrossRefGoogle Scholar
  22. 22.
    Yamashita O, Funamoto K, Hayase T. Development of poly(vinyl alcohol) gel with in vivo acoustic properties. In: Proceedings of GPBE/NUS-Tohoku graduate student conference in bioengineering. 2008. p. 30–31.Google Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2013

Authors and Affiliations

  • Lei Liu
    • 1
    Email author
  • Kenichi Funamoto
    • 2
  • Kei Ozawa
    • 3
  • Makoto Ohta
    • 2
  • Toshiyuki Hayase
    • 2
  • Masafumi Ogasawara
    • 1
  1. 1.GE Healthcare Japan CorporationHinoJapan
  2. 2.Institute of Fluid ScienceTohoku UniversitySendaiJapan
  3. 3.Graduate School of Biomedical EngineeringTohoku UniversitySendaiJapan

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