Performing magnetic resonance imaging in patients with gunshot wounds: a guide for radiologists

INTRODUCTION: The safety of magnetic resonance imaging (MRI) in patients with metallic foreign bodies is an important aspect that has been the subject of many scientific papers and guidelines. The issue of MRI in patients with implanted medical devices is well researched. However, for gunshot wounds, there are no clear guidelines for practitioners, and most recommendations are to refuse to perform the study if there is the slightest doubt about its safety. OBJECTIVE: To systematize information on the safety and quality of MRI in patients with gunshot wounds and to develop practical guidelines for radiologists. MATERIALS AND METHODS: We have analyzed and summarized the main domestic and foreign recommendations for ensuring safety during MRI, generally accepted classifications and mechanisms of gunshot wounds. RESULTS: A review of physical risk factors in MRI, their causes, and recommendations for their minimization is presented. The influence of metallic objects on the appearance of artefacts on MRI images is considered. The algorithm of decision making on the safety of MRI in a patient with a bullet or shotgun wound is given. Two clinical observations are presented to illustrate the application of this algorithm. CONCLUSION: Performing MRI in gunshot wounds is feasible but requires careful analysis of the risks and the importance of diagnostic information. Interviewing the patient in these situations is often uninformative, so radiography or CT are the methods of choice for detection of metallic foreign bodies. To minimize the risks of MRI, a scan protocol should be prepared in advance and the patient should be monitored after each pulse sequence.