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Objective: Accurate characterization of urinary stones is very important in that it effects choice, and outcome of the treatment using imaging techniques various characteristics of the stones including their size, configuration, and location can be determined. In this study we aimed to determine the correlation between the composition of the kidney stones with the twinkling artifact in Color Doppler Ultrasound, and the mean density in the noncontrast-enhanced computed tomography (NCECT). Methods: A total of 49 patients who had kidney stones with an indication for surgery were included in this prospectively planned study. All patients were examined with the NCECT for the mean density measurement in Hounsfield units, and using Color Doppler ultrasound for the twinkling artifact before the surgery. Results: Forty-one (83.68 %) renal stones were composed purely of a single element,while 8 (16.32%) kidney stones composed of two elements.Renal stones only with calcium and non-calcium stones had different mean densities in NCECT, and the cut-off value was calculated as 644.5 Hounsfield Unit (p<0.001). After analyzing kidney stones according to this cut-off value, there was a statistically significant association between the composition of the stone and the twinkling artifact with the stones which had a lower mean density than the cut-off value (p=0.014). The kidney stones with a mean density below this cut off value with grade 0-1 twinkling artifact were uric acid stones, and those with grade 2 twinkling artifact were cystine stones. The kidney stones with a mean density above the cut off value, any statistically significant association between the twinkling artifact and composition of the stones was not detected (p=0.203), but all kidney stones with grade 1 twinkling artifact were found to be calcium oxalate monohydrate. While 83.3%, and 16.7% of the stones with Grade 2 stones with a density above cut-off value were found to be composed of calcium oxalate monohydrate, and calcium oxalate dihydrate, respectively Conclusion: The twinkling artifact of the kidney stones in Color Doppler Ultrasound and the mean density in NCECT, can be used for the characterization of the kidney stones and it is helpful for the right treatment of choice.

Characterization Of Kidney Stones With Imaging Modalities: Twinkling Artifact In Color Doppler Ultrasound And Density In Non-Contrast-Enhanced CT