Is a titanium surgical stapler left in the abdomen a contraindication for MRI?

Titanium Surgical Staplers Are NOT a Contraindication for MRI

Titanium surgical staplers left in the abdomen are safe for MRI scanning and do not represent a contraindication. Titanium is a nonferromagnetic material that exhibits minimal to no deflection forces in magnetic fields, making it one of the safest metals for MRI compatibility 1, 2.

MRI Safety Classification of Surgical Staplers

Titanium Staplers: MRI-Safe

• Titanium and titanium alloy staplers demonstrate no significant magnetic field interactions at standard clinical MRI field strengths (1.5T and 3.0T) 1, 2.
• Testing of metallic surgical implants at 3-Tesla showed only minor deflection angles (20-27 degrees) for stainless steel staples, which is considered acceptable from a safety perspective, while titanium performs even better 2.
• No clinically significant heating occurs with surgical staples during MRI scanning—temperature changes remain ≤1.6°C even at whole body averaged SAR of 2.9 W/kg for 15 minutes 2.
• No displacement or movement of surgical staples occurs during standard MRI scanning, as demonstrated in experimental studies 3.

Stainless Steel Staplers: Also Generally Safe

• Even stainless steel surgical staples (which have higher magnetic susceptibility than titanium) have been proven safe for MRI scanning 3, 2.
• A study of 30 specimens with stainless steel staples showed no measurable displacement and actually demonstrated a slight decrease in skin surface temperature (0.43°C) after 35-minute MRI scans at 1.5-Tesla 3.

Artifact Considerations (Not Safety Issues)

• The primary concern with surgical staplers in MRI is image artifact, not patient safety 2.
• Artifacts from metallic staplers may create signal voids and geometric distortions that could compromise diagnostic quality if the area of interest is in the same location as the staples 2.
• Titanium produces significantly less artifact than stainless steel, making it the preferred material for surgical implants when future MRI imaging is anticipated 4, 1.

Clinical Decision Algorithm

Step 1: Confirm the stapler material

• If titanium or titanium alloy → Proceed with MRI without restriction 1, 2
• If stainless steel → Proceed with MRI without restriction 3, 2
• If unknown material → Assume safe and proceed (the vast majority of modern surgical staplers use MRI-compatible materials) 1, 2

Step 2: Consider artifact impact on diagnostic quality

• If the imaging target is distant from the stapler location → No modification needed 2
• If the imaging target is at or near the stapler location → Inform radiologist to optimize sequences (use T1-weighted spin echo rather than gradient echo to minimize artifact) 2

Step 3: Document stapler presence

• Note the presence and approximate location of surgical staplers in the MRI safety screening checklist 5
• This allows radiologists to anticipate potential artifacts and adjust imaging protocols accordingly 2

Important Caveats

The One Historical Exception

• A single defective batch of McGee stapes prostheses manufactured in 1987 with magnetic alloy represents the only documented contraindication for MRI among surgical staples 4.
• This applies specifically to ear stapedectomy prostheses, not abdominal surgical staplers 4.
• No other adverse outcomes have been causally substantiated with any other surgical staples exposed to MRI fields 4.

General MRI Safety Principles

• All metallic items must be removed from patients before MRI, including external jewelry, dental prostheses, and clothing with zippers 5.
• The MRI safety classification system categorizes devices as "MRI unsafe," "MRI conditional," or "MRI safe"—surgical staplers made of titanium or stainless steel fall into the "MRI safe" or "MRI conditional" (with minimal restrictions) categories 5, 1.

Modern Surgical Practice

• Manufacturers increasingly use nonferromagnetic metals such as titanium for surgical staplers specifically to ensure MRI compatibility 4.
• Titanium staplers are now standard in gastrointestinal anastomosis and other surgical applications 6.

Bottom Line for Clinical Practice

Do not delay or deny MRI imaging in patients with titanium or stainless steel surgical staplers in the abdomen. These devices pose no safety risk to patients and should not be considered contraindications 3, 1, 2. The only consideration is potential image artifact, which can be managed through appropriate imaging technique selection and does not represent a patient safety concern 2.