Using 3-D-Printed Structures to Evaluate the Potential Causes of the Color Doppler Twinkling Signature

Objective: The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation occurring on rough objects such as kidney stones, some breast biopsy clips, catheter guidewires and sandpaper. The objective was to investigate the correlation between the surface characteristics of helical constructs with different groove geometries and the occurrence of twinkling, as well as to identify locations conducive to bubble retention and\/or cavitation.Methods: Six half-cylinders were created with a microscale 3-D printer with 5 \u00b5m resolution to replicate the geometry of twinkling helical constructs resembling catheter guidewires. Four copies of each marker including a non-twinkling control were printed. The half-cylinders had pitch (peak-to-peak distance) values ranging from 87.5 to 343 \u00b5m and amplitude (groove depth) values ranging from 41.5 to 209 \u00b5m. The half-cylinders were submerged in degassed water and optically imaged before and after ultrasound insonification to visualize bubbles on the cylinders. The cylinders remained submerged while scanning with the color Doppler mode at frequencies from 3.1 to 6.3 MHz using a GE Logiq E9 scanner and 9L linear array transducer.Results: Two markers exhibited twinkling: one with pitch-to-amplitude ratio of 174\/210 \u00b5m\/\u00b5m (0.8) that twinkled only with pre-existing bubbles on the marker; the other had a ratio of 87\/87 \u00b5m\/\u00b5m (1.00) that twinkled without pre-existing bubbles on the marker.