The aim of the study was to evaluate whether the twinkle artefact is a valuable feature in the sonographic diagnosis of superficial epidermoid cysts.
Materials and methods
A retrospective search was undertaken of our institution’s Radiology Information System and pathology database to identify cases of superficial masses showing the twinkle artefact that proceeded to surgical excision.
Results
Eighteen superficial masses demonstrating the twinkle artefact were identified that were submitted for pathological analysis. Of these, 17 were confirmed to represent epidermoid cysts and only 1 case had an alternative diagnosis (proliferating trichilemmal cyst).
Conclusion
The presence of the twinkle artefact appears to be a specific and valuable ancillary sonographic feature for the diagnosis of superficial epidermoid cysts.
DillmanJRKappilMWeadockWJ. Sonographic twinkling artifact for renal calculus detection: correlation with CT. Radiology2011; 259: 911–916.
2.
RahmouniABargoinRHermentA. Color Doppler twinkling artifact in hyperechoic regions. Radiology1996; 199: 269–271.
3.
WinkelRRKalhaugeAFredfeldtK-E. The usefulness of ultrasound colour-Doppler twinkling artefact for detecting urolithiasis compared with low dose nonenhanced computerized tomography. Ultrasound Med Biol2012; 38: 1180–1187.
4.
KimHCYangDMJinW. Color Doppler twinkling artifacts in various conditions during abdominal and pelvic sonography. J Ultrasound Med2010; 29: 621–632.
5.
HungEHGriffithJFNgAW. Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. Amer J Roentgenol2014; 202: W532–W540.
6.
HuangCCKoSFHuangHY. Epidermal cysts in the superficial soft tissue sonographic features with an emphasis on the pseudotestis pattern. J Ultrasound Med2011; 30: 11–17.
7.
LeeJYKimSHChoJY. Color and power Doppler twinkling artifacts from urinary stones: clinical observations and phantom studies. Amer J Roentgenol2001; 176: 1441–1445.
8.
KamayaATuthillTRubinJM. Twinkling artifact on color Doppler sonography: dependence on machine parameters and underlying cause. Amer J Roentgenol2003; 180: 215–222.
LuWSapozhnikovOABaileyMR. Evidence for trapped surface bubbles as the cause for the twinkling artifact in ultrasound imaging. Ultrasound Med Biol2013; 39: 1026–1038.
11.
ChiouHJChouYHChiuSY. Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color Doppler ultrasonography. J Chinese Med Assoc2009; 72: 307–315.
12.
WagnerJMLeeKSRosasH. Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med2013; 32: 1443–1450.
13.
DiDomenicoPMiddletonW. Sonographic evaluation of palpable superficial masses. Radiol Clin North Am2014; 52: 1295–1305.
14.
BelliPCostantiniMMirkP. Role of color Doppler sonography in the assessment of musculoskeletal soft tissue masses. J Ultrasound Med2000; 19: 823–830.
15.
KuwanoYIshizakiKWantanabeR. Efficacy of diagnostic ultrasonography of lipomas, epidermal cysts, and ganglions. Arch Dermatol2009; 145: 761–764.
GiessCSRazaSBirdwellRL. Distinguishing breast skin lesions from superficial breast parenchymal lesions: diagnostic criteria, imaging characteristics, and pitfalls. RadioGraphics2011; 31: 1959–1972.
18.
YasumotoMShibuyaHGomiN. Ultrasonographic appearance of dermoid and epidermoid cysts in the head and neck. J Clin Ultrasound1991; 19: 455–461.
19.
DenisonCMWardVLLesterSC. Epidermal inclusion cysts of the breast: three lesions with calcifications. Radiology1997; 204: 493–496.
20.
LeeHSJooKBSongHT. Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound2001; 29: 374–383.
