Twinkling artifact in color Doppler imaging of the orbit.

OBJECTIVE To show an artifact related to color Doppler flow imaging of the orbit. METHODS Three patients with strongly reflective structures in the orbit were selected from those routinely referred by clinicians for color Doppler ultrasonography of the orbit. Gray scale and color flow images were obtained with a 7.5-MHz linear array probe for a region with strongly reflective structures. A spectral display was acquired to confirm the presence of blood flow. RESULTS One patient had a metallic foreign body just behind the bulb; another had calcification within the irregular mass of phthisis bulbi; and the third had hyperechoic drusen in the periphery of the intraocular melanoma. The color mosaic, suggesting the presence of blood flow, was detected beyond all hyperechoic structures. Close vertical bands with no outer wrapping were detected in the spectrum display, obtained by placing the sample volume on the region of color flow. The artificial color flow was recognized as a color Doppler twinkling artifact. CONCLUSIONS The color flow beyond the strongly reflecting structures in the orbit might be mistakenly interpreted as real blood flow if an examiner is not familiar with the artifact. It should prompt further imaging with spectral Doppler ultrasonography.