Potential hazards and artifacts of ferromagnetic and nonferromagnetic surgical and dental materials and devices in nuclear magnetic resonance imaging.

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Abstract
The risks to patients with metal surgical implants who are undergoing NMR imaging and the artifacts caused by such implants were studied. Twenty-one aneurysm and other hemostatic clips and a variety of other materials (e.g., dental amalgam, 14 karat gold) were used. Longitudinal forces and torques were found to be exerted upon 16 of the 21 clips. With 5 aneurysm clips, forces and torques sufficient to produce risk of hemorrhage from dislocation of the clip from the vessel or aneurysm or cerebral injury by clip displacement without dislodgement were identified. The induced ferromagnetism was related to the composition of the alloys from which the clips were manufactured. Clips with 10-14% Ni are evidently without sufficient induced ferromagnetism to cause hazard. The extent of NMR imaging artifacts was greater for materials with measurable ferromagnetic properties, but metals without measurable ferromagnetism in these tests also resulted in significant artifacts. Dental amalgam and 14 karat gold produced no imaging artifacts, but stainless steels in dentures and orthodontic braces produced extensive artifacts in the facial region.