B-Mode Sonography Versus Color Doppler Twinkling Artifact in the Diagnosis of Nephrolithiasis

Background: Nephrolithiasis, or kidney stones, is a prevalent condition that prompts numerous patient visits to emergency departments worldwide. The diagnosis of this condition and its complications, such as hydronephrosis, has traditionally relied on various imaging modalities, with ultrasound being a primary, non-invasive option. Recent advancements, including the utilization of the color Doppler twinkling artifact, have potentially enhanced the diagnostic capabilities of ultrasound for nephrolithiasis. Objective: This study aims to evaluate the effectiveness of B-mode sonography and the color Doppler twinkling artifact in the diagnosis of nephrolithiasis and to compare their sensitivity in detecting renal stones and associated hydronephrosis. Methods: A cross-sectional study was conducted at the Department of Radiology, Mahaban Medical and Research Hospital, Topi, Pakistan, from December 2023 to March 2024. Seventy patients presenting with flank pain and aged above 18 years were enrolled. Sonographic examinations were performed using a TOSHIBA Xario Prime ultrasound machine. Data were analyzed using SPSS version 25.0, focusing on the presence of renal stones and hydronephrosis as detected by B-mode sonography and the color Doppler twinkling artifact. Results: Of the 70 patients studied, renal stones were detected in 70% (n=49) via the color Doppler twinkling artifact, while 30% (n=21) showed no stones. Hydronephrosis was observed in 30% (n=21) of patients, with an equal distribution between the left and right kidneys. The mean age of participants was 34.56 years, with a gender distribution of 62.9% male and 37.1% female. The twinkling artifact demonstrated a 100% sensitivity in identifying renal calculi among patients presenting with flank pain. Conclusion: The color Doppler twinkling artifact, when used alongside B-mode sonography, provides a highly sensitive diagnostic tool for nephrolithiasis, underscoring its potential as a primary imaging modality in the evaluation of patients with suspected renal stones. This study highlights the importance of ultrasound in the early detection and management of kidney stones, offering significant implications for improving patient care in healthcare settings lacking advanced imaging technologies.