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Twinkling Artifact is a valuable tool in detecting dense objects such askidney stones, calculi etc., especially when there is no acoustic shadowing andpresence of hyperechogenic tissues obstructs visualization. This phenomenon isnot completely understood. Different scientific groups have contradictoryfindings concerning its properties: some of them observed a decrease inTwinkling intensity at elevated pulse repetition frequencies (PRF), whileothers found Twinkling to be independent from PRF, etc. In this paper wehypothesize that this kind of contradictions can be partially resolved on anassumption that there are two types of Twinkling. The 1st type presumably isproduced by random-phased reflections from microcavitation and can beregistered even at PRF high enough to suppress blood flow. The 2nd isoriginated from elastic vibrations as the object under investigation swingslike a pendulum in the field of ultrasound. These vibrations can be associatedwith an external source such as a muscles contraction, etc. or the acousticradiation force from signals emitted by the transducer. The 2nd type ofTwinkling disappears at high PRF and can be regularly observed in silicone andpolyurethane phantoms where the occurrence of cavitation microbubbles is highlyunlikely. Key Words: Ultrasound Imaging, Twinkling Artifact, Stone Detection,Doppler Effect, Color Frame Mapping, Acoustic Radiation Force, ElasticVibration, Ultrasound Phantom, Cavitation, Microbubbles.

Discovery of Two Types of Twinkling Can Explain Contradictory Observations among Twinkling Artifact Investigators in Ultrasound Imaging