Are the staples used during laparoscopic (lap) cholecystectomy magnetic resonance imaging (MRI) friendly?

MRI Compatibility of Surgical Clips Used in Laparoscopic Cholecystectomy

Both titanium metal clips and non-absorbable polymer clips used during laparoscopic cholecystectomy are MRI-safe and will not cause harm to patients undergoing MRI, though titanium clips may create local imaging artifacts that can obscure adjacent structures.

Clip Types and MRI Safety

Titanium Metal Clips

• Titanium clips are MRI-safe (not ferromagnetic) and do not pose a safety risk during MRI scanning 1, 2, 3
• Titanium is a non-ferromagnetic material that does not experience significant attraction or movement in the magnetic field 1, 2
• However, titanium clips can create susceptibility artifacts on MRI images, appearing as signal voids or distortions that may obscure visualization of adjacent biliary structures 4, 5
• These artifacts are particularly relevant when performing MRCP (magnetic resonance cholangiopancreatography) to evaluate the biliary tree postoperatively 4, 5

Non-Absorbable Polymer Clips

• Polymer clips are completely MRI-compatible with no artifact generation, making them superior for patients who may require future biliary imaging 3
• These clips have a locking mechanism and demonstrate comparable safety profiles to metal clips during laparoscopic cholecystectomy 3
• The absence of metal eliminates susceptibility artifacts, allowing for unobstructed visualization of the biliary tree on subsequent MRCP studies 3

Absorbable Clips

• Absorbable clips are MRI-safe and eventually dissolve, eliminating any long-term imaging concerns 1, 2
• These clips demonstrate equivalent efficacy to titanium clips for hemostasis and cystic duct ligation during laparoscopic cholecystectomy 1, 2
• By the time significant imaging is needed postoperatively, absorbable clips have typically degraded and are no longer present 1, 2

Clinical Implications for MRI Imaging

MRCP Performance After Cholecystectomy

• MRCP is the preferred imaging modality for evaluating the biliary tree postoperatively, with sensitivity of 85-100% and specificity of 90% for detecting bile duct stones and obstruction 6, 5
• Titanium clips may create local signal voids on MRCP images, potentially obscuring the cystic duct stump or adjacent common bile duct 4, 5
• Despite artifacts, MRCP remains highly accurate for detecting anatomical variants and pathology in post-cholecystectomy patients 4, 5

Practical Considerations

• No special precautions or contraindications exist for performing MRI in patients with surgical clips from laparoscopic cholecystectomy 1, 2, 3
• Radiologists should be informed about the presence and type of clips to optimize imaging protocols and interpretation 4, 5
• If detailed visualization of the cystic duct stump region is critical, polymer clips offer superior imaging characteristics compared to titanium 3

Common Pitfalls to Avoid

• Do not delay or refuse MRI imaging in patients with surgical clips from cholecystectomy—all commonly used clips are MRI-safe 1, 2, 3
• Do not confuse MRI safety with image quality—while titanium clips are safe, they may create artifacts that complicate interpretation 4, 5
• Do not assume all metal clips are contraindicated for MRI—titanium is non-ferromagnetic and poses no safety risk 1, 2