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Black hole artifacts-a new potential pitfall for DXA accuracy?

Sarah L Morgan1, Robert Lopez-Ben, Nancy Nunnally

  • 1Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294-1270, USA. slmorgan@uab.edu

Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry
|February 23, 2008
PubMed
Summary

Black hole artifacts in dual-energy X-ray absorptiometry (DXA) scans, caused by metals like tantalum, can affect bone mineral density (BMD) results. Viewing scans in single-energy mode helps identify these artifacts and verify results.

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Area of Science:

  • Radiology
  • Biomedical Engineering
  • Materials Science

Background:

  • Dual-energy X-ray absorptiometry (DXA) is a common method for assessing bone mineral density (BMD).
  • Metallic objects can cause artifacts, specifically "black hole" artifacts, on DXA scans, potentially mimicking low bone density.
  • The impact of these artifacts on BMD measurements, particularly with surgical clips, requires investigation.

Purpose of the Study:

  • To investigate the effect of metallic surgical clips, specifically tantalum, stainless steel, and titanium, on DXA scan results.
  • To determine if "black hole" artifacts caused by these metals significantly alter bone mineral density (BMD) measurements in phantom and cadaveric spine specimens.
  • To assess the utility of single-energy scans in identifying these artifacts.

Main Methods:

  • Surgical clips made of tantalum, stainless steel, and titanium, along with bullets, were placed on a Hologic spine phantom's third lumbar vertebra (L3).
  • Tantalum and stainless steel clips were also placed on L3 of cadaveric spines (high and low density) with soft tissues.
  • DXA scans were performed, and results were compared between specimens with and without metallic objects, including analysis of single-energy scans.

Main Results:

  • Tantalum clips created "black hole" artifacts on DXA scans, while stainless steel and titanium appeared as white objects.
  • In high-density spines, eight tantalum clips significantly lowered L3 BMD, but overall L1-L4 BMD was not significantly affected.
  • In low-density spines, tantalum clips at L3 significantly altered single vertebral body BMD and potentially L1-L4 BMD, with single-energy scans aiding artifact identification.

Conclusions:

  • "Black hole" artifacts from certain metals, like tantalum surgical clips, can occur in DXA scans.
  • Localized BMD can be decreased by these artifacts, but the effect on overall L1-L4 spine BMD varies with bone density.
  • Clinicians should be aware of potential DXA artifacts from metallic implants and utilize single-energy scans for verification to ensure accurate BMD assessment.