“Black Hole Artifacts”—A New Potential Pitfall for DXA Accuracy?
Abstract
Certain types of metallic objects apparently have high attenuation (a white image) on dual-energy X-ray absorptiometry (DXA) scan images, but instead show up as black (black hole artifacts). When small, these artifacts may easily be missed on visual inspection. We hypothesized that such "black hole" artifacts could have a significant effect on bone mineral density (BMD) results. Human use approval (Institutional Review Board [IRB]) was obtained to publish patient scans and an IRB waiver was obtained for nonhuman research. We placed individual surgical clips and cassettes of clips of tantalum, stainless steel and titanium, and a bullet over the third lumbar vertebra (L3) of a Hologic spine phantom. In addition, 4 or 8 individual tantalum or stainless steel clips and tantalum squares were placed over L3 of cadaveric spines (high-density spine L1-L4 BMD=1.049 g/cm2) and low-density spine BMD (L1-L4 BMD=0.669 g/cm2) with attached soft tissues. Stainless steel and titanium clips scanned as white objects with DXA. A bullet and tantalum clips scanned black (black holes). All clip types were visible on single-energy scans as white objects. Eight tantalum clips significantly lowered L3 BMD compared to 4 or 0 clips in the high-density spine. There were no significant differences in BMD L1-L4 between 0, 4, and 8 tantalum clips in the high-density spine. In the low-density spine, 8 tantalum clips over L3 had significantly lower BMD compared to 4 tantalum clips overlying L3 and 4 clips…
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