This study explores the enhancement of diagnostic accuracy using Color Doppler Ultrasound (CDUS) combined with the twinkling artifact (TA) to detect small, soft-tissue foreign bodies (FBs) that are difficult to visualize on traditional grayscale ultrasound (US). In clinical practice, patients frequently present with discomfort caused by small FBs in soft tissues, which can be challenging to detect using standard US grayscale imaging alone. This paper enrolled seven adult patients who exhibited small, superficial FBs measuring between 2 and 4 millimeters in the subcutaneous and muscle tissues, which were minimally or entirely undetectable on grayscale US. Each patient underwent both grayscale US and CDUS to assess the visibility of FBs with TA. Remarkably, in all cases, the CDUS examination revealed the presence of FBs through the twinkling artifact, which appeared as a bright, flashing signal that indicated the exact position of the FBs. Following surgical excision, these artifacts were confirmed to be foreign bodies, supporting the diagnostic effectiveness of CDUS combined with TA. The twinkling artifact provided valuable information on the FBs’ precise location, depth, and shape, enhancing the quality of pre-surgical assessments and surgical planning. This study highlights that TA is a useful adjunct to grayscale US for the identification and evaluation of small FBs in soft tissues, offering greater diagnostic accuracy and improving patient outcomes. These findings suggest that TA in CDUS can serve as a reliable diagnostic tool in clinical settings, especially for cases where FBs are challenging to detect on grayscale US and surgical removal is indicated. This approach may contribute significantly to the improved management of patients with FB-related discomfort, optimizing diagnosis, and treatment.
