Tiny ferromagnetic intraocular foreign bodies detected by magnetic resonance imaging: a report of two cases

We report two cases with tiny ferromagnetic intraocular foreign bodies (FBs) that were demonstrated only on magnetic resonance imaging (MRI) and confirmed by subsequent ophthalmologic operation. Both of the patients had a history of ocular trauma and their clinical symptoms were compatible with an intraocular FB. Plain x-ray film, 3 mm slice thickness computed tomography (CT) scans (Toshiba TXT 600 system and GERP22 system), B-scan ultrasonography, and an MRI study (Siemens Impact 1.0 MR system) were acquired. MR examinations were performed using spin-echo (SE) T1, T2, and PD-weighted axial and sagittal or coronal images with 3 mm slice thickness. Plain x-ray film, 3 mm slice thickness CT scans and B-scan ultrasonography all failed to demonstrate any tiny intraocular FBs in these two patients, whereas MRI revealed tiny ferromagnetic FBs due to their characteristic magnetic susceptibility artifact. A ferromagnetic FB was found in the vitreous body of each patient, which were 0.375x0.3x0.15 mm and 0.5x0.4x0.2 mm, respectively, and there was no evidence of MR-induced damage. We suggest that tiny ferromagnetic fragments with a diameter below 0.5 mm, which are too small to be visualized by x-ray plain films and CT images, may be visualized on MR images. These tiny ferromagnetic particles may not be large enough to cause ocular damage during a 1.0T MRI examination. MRI may be a useful tool in the evaluation of tiny intraocular ferromagnetic FBs if other imaging modalities such as plain s-ray, CT scan, and ultrasonography failed to do so. Further evaluation with a large-scale study (in vitro and in vivo animal study) for the safety of detecting tiny (<0.5 mm) intraocular ferromagnetic particles is warranted.