Background: The characterization of renal and ureteric calculi composition has been explored using various imaging techniques. The study aimed to assess the correlation of ultrasound twinkling artifacts with Dual Energy Computed Tomography (DECT) in this context.

Aims and Objectives: Establish the association between the composition of renal stones and the presence and grading of twinkling artifacts using color Doppler, in comparison with Dual Energy CT.

Determine the sensitivity and specificity of ultrasound twinkling artifact vis-à-vis Dual Energy CT.

Methods: A total of 50 patients with a history of flank pain, haematuria, difficulty in micturition, or known renal and ureteric calculi were included after receiving ethical committee clearance and informed consent. These patients underwent an ultrasound KUB, followed by DECT KUB. The ultrasound, performed using Philips Affiniti 50 & Philips HD 15 machines, utilized a curvilinear probe of 2-5 MHz. The DECT KUB was conducted with a Siemens 128-slice CT scanner. Findings from the ultrasound were then compared to DECT KUB results regarding stone composition.

Results: The study identified 67 stones of four different compositions: 32 calcium oxalate, 10 calcium hydroxyapatite, 20 uric acid, and 5 cystine. Twinkling artifact grading on ultrasound color doppler was as follows: grade 0 (23 stones with no artifact), grade 1 (17 stones with less than half the surface showing the artifact), and grade 2 (27 stones fully exhibiting the artifact). When cross-referenced with DECT KUB results, no substantial correlation was found between twinkling artifact grades and renal stone morphology.

Conclusion: The in vivo study involving 50 patients found no significant correlation between the grades of twinkling artifacts on ultrasonography and the results of DECT KUB in characterizing renal stone morphology. The ultrasound twinkling artifact, although not definitive for morphology determination, exhibited a correlation showing 95.8% sensitivity and 87% specificity statistically.