Imaging Appearance of Ballistic Wounds Predicts Bullet Composition: Implications for MRI Safety.

OBJECTIVE. The purpose of this article was to determine whether the radiographic and CT appearance of ballistic projectiles predicts their composition and to characterize the translational, rotational, and temperature effects of a 1.5-T MRI magnetic field on representative bullets. MATERIALS AND METHODS. Commercially available handgun and shotgun ammunition representing projectiles commonly encountered in a clinical setting was fired into ballistic gelatin as a surrogate for human tissue, and radiographs and CT images of these gelatin blocks were obtained. MR images of unfired bullets suspended in gelatin blocks were also obtained using T1- and T2-weighted sequences. Magnetic attractive force, rotational torque, and heating effects of unfired bullets were assessed at 1.5 T. RESULTS. Fired bullets were separated into ferromagnetic and nonferromagnetic groups based on the presence of a debris trail and deformation of the primary projectile in the gelatin blocks. Whereas ferromagnetic bullets showed mild torque forces and marked imaging artifacts at 1.5 T, nonferromagnetic bullets did not have these effects. Heating above the Food and Drug Administration limit of 2°C was not observed in any of the projectiles tested. CONCLUSION. Patients with ballistic embedded fragments are frequently denied MRI because the bullet composition cannot be determined without shell casings. We found that radiography and CT can be used to identify nonferromagnetic projectiles that are safe for MRI. We also present an algorithm for determining the triage of patients with retained bullets.