Microscopic observation of glass bead movement in soft tissue-mimicking phantom under ultrasound PW mode scanning

Previous studies have demonstrated that stones and calcification in soft tissue show special enhancement in response to color flow (CF) or pulse Doppler (PW) mode ultrasound scan. This phenomenon is known as the “twinkling sign (TS)”. The authors conducted an in vitro experiment to investigate the mechanism of TS occurrence by observing a glass bead in a transparent PVA-H soft tissue-mimicking phantom. The TS in PW mode showed a low-power and slow-velocity spectrum. At the same time, analysis of images by high-speed camera showed that the glass bead in the phantom oscillated following the pulse repetition frequency (PRF) of the PW mode ultrasound scan. The harmonic oscillations were confirmed, as well. The ultrasound radiation force-driven micro-oscillation possibly affects the ultrasound propagation around the scatterer and triggers random signals in the received echo signals. The results indicate that TS is a phenomenon based on complicated acoustic–mechanical interaction of multiple mechanisms. Further investigation is required for gaining a full understanding of the mechanism of TS occurrence and its clinical application.