E2554. Is It MR Compatible? A Radiologist’s Guide to Assessing Endoscopic Biopsy and Hemostasis Clips for MRI Compatibility
  1. Donald Lee; Staten Island University Hospital
  2. Jihyun Kang; Staten Island University Hospital
  3. Hannah Bae; Staten Island University Hospital
  4. Mira Alsheikh; Staten Island University Hospital
Prior to approving MR imaging of a patient, the radiologist has the important role of deciding if the patient has any metallic implant or hardware that may endanger the patient during examination. The American Board of Radiology releases a noninterpretive skills study guide annually with a section that discusses various aspects of MR safety that every radiology trainee should know including zoning and screening, MR imaging in pregnant patients, and MR imaging in patients with intracranial aneurysm clips and pacemakers. Notably, there is no section discussing the MR compatibility of colonoscopy hemostasis or biopsy clips. In addition, given the various manufacturers and materials used for these clips, it is important for the radiologist to be aware of that variety in order to safely approve an MR examination of a patient containing one of the many clips available on the market.

Educational Goals / Teaching Points
The planned presentation will begin with various abdominal radiographs and/or abdominal computed tomography (CT) images obtained from our institution demonstrating various bowel biopsy or hemostatic clips used in patients post-colonoscopy. The radiological images of the various clips will then be correlated to live photos of the clips with a description of its manufacturer and MR compatibility. In addition, the natural history of retention for these clips within the gastrointestinal tract will be outlined. The main purpose of providing this information is for the radiologist to make an informed decision when deciding if a patient with recent endoscopy and placement of clips can safely undergo an MR examination. One factor is being able to identify the type of clip or even the manufacturer of a clip when possible and knowing if it is MR compatible. Another factor is knowing a timeframe of how long the clips can remain in the gastrointestinal tract so that an examination can be deferred to a certain later date once the clips have been expelled. The clinical significance of this knowledge is that there is a concern of manipulation of ferromagnetic clips during MR examination that could lead to gastrointestinal injury or bleeding.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This educational exhibit will utilize various radiographic and/or CT images, from our institution, of patients with biopsy or hemostasis clips following endoscopy. This will act as a pictorial guide for identifying various clips and aid the radiologist in the planning and approval process for a safe MR examination.

Provide a radiological and pictorial case series of various hemostatic and biopsy clips in patients post endoscopy to aid the radiologist in safe approval of MR examination in patients with post endoscopic clips.