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Abstract
Objective: To determine the diagnostic accuracy of ultrasound twinkling artifact in identifying ureter calculus taking CT pyelogram as a gold standard.
Study design and setting: This cross-sectional study was done at the Radiology Department of Dr. Ziauddin Hospital Karachi
Methodology: The study was conducted over a period of six months from Jan 01, 2025 till June 30, 2025. A total of 272 patients of both genders aged between 18 to 75 years presenting with sudden onset flank pain suspicious of acute ureteric stones were included using consecutive (non-probability) sampling. All cases underwent conventional ultrasound with color Doppler assessment for twinkling artifact followed by CT pyelogram.
Results: The average age of cases was 44.5 ±11 years, with 135 (49.6%) males and 137 (50.4%) females. The ureterovesical junction was the most common stone location (37.5%), followed by distal (22.8%), mid (21.0%), and proximal ureter (18.8%). The overall sensitivity of ultrasound twinkling artifact was 96.1%, specificity was 85.40%, PPV 97.40%, NPV 79.5%, and overall accuracy 94.4%.
Conclusion: Ultrasound twinkling artifact demonstrates very high diagnostic accuracy for detecting ureteric calculus with high sensitivity and positive predictive value. The diagnostic performance remains consistently high across different genders, stone locations, and BMI categories.