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Objectives: The goal of this ex vivo study was to determine if Dual-Energy Computed Tomography (DECT) can discriminate ferromagnetic bullets from non-ferromagnetic bullets. Methods: Twelve different bullets, placed in the center of the scanner on a gelatin phantom, underwent DECT evaluation. These projectiles were both ancient bullets from the 19Th century (eg. 8mm 1890 ECP) and recent bullets from the late 20th century (eg. 9mm Lüger; 7.92mm Mauser; 7mm sport carabin). Two independent radiologists who were blinded to the properties of bullets performed all measurement on an external workstation with extended CT scale. Regions of interest (ROI) were placed in the core of each projectile. From these data, a dual-energy index (DEI) was calculated. A bootstrap method with a p value of less than 0.05 was used to demote statistical significance. Results: Five bullets were ferromagnetic and seven were non-ferromagnetic. The DEI calculated were significantly (p<0.05) different between the ferromagnetic and nonferromagnetic projectiles. There were no significant difference (p>0.05) for intrareader and interreader agreement analysis. Conclusion: Dual-energy CT, despite several limitations, could be a valid method to differentiate ferromagnetic from non-ferromagnetic bullets in an ex-vivo environment with extended CT-scale. This approach could contribute to MR safety but further studies are necessary before using dual-energy CT as a routine technique for screening gunshots victims.

Military and law enforcement non-nickel- or nonsteel-containing bullets appear to be safe for patients in MRI system at 1.5 and 3 T. On the other hand, nickel- and steel-containing bullets exhibit movements that are considered potentially unsafe for patients in an MRI environment.

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