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Tattoos and MRI

The Hospital for Sick Children
Toronto M5G 1X8, Canada

We report a case of body tattoos interfering with MRI and briefly review the effects of MRI on tattoos.

An 18-year-old man, who was a long-term survivor of Hodgkin's lymphoma, presented with back pain and urinary hesitancy. He had gone to the oncology clinic with abdominal pain 2 weeks earlier. Results of an extensive examination including detailed neurologic examination, lumbosacral radiography, and sonography of the abdomen were unremarkable. An outpatient MRI study had to be terminated after two attempts because the patient complained of a severe burning sensation from the tattoos on his back and upper arms.

An urgent myelogram showed a complete block at the T12 and L1 level, suggestive of a spinal cord tumor. Of note, findings of CT scans of the chest, abdomen, and pelvis were normal. The patient had an uncomplicated recovery after an undifferentiated sarcoma was resected and he is currently undergoing radiotherapy. It has not been possible to assess the completeness of the resection or the status of the tumor on MRI because of his extensive body tattoos.

A survey of 135 patients with cosmetic tattoos who underwent MRI showed that only two of them had minor transient complications of tingling or burning sensations, which did not interfere with the procedure [1]. Applying cool compresses or ice packs over the tattoos has been suggested to counteract the MRI-induced heating.

Three isolated case reports of tattoo-induced skin burns during MRI have been published [2-4]. The first [2] was an MRI examination that was interrupted because a dragon tattoo caused a burning sensation. The second case [3] was an MRI examination that was interrupted because of a burning sensation from a tattoo of a red rose on a black background. The patient later underwent tattoo excision to permit MRI. The third report [4] described second-degree burns during MRI in both deltoid areas that were caused by tattoos of black thunderbolts.

All three reported cases and our patient had dark black tattoos that caused a burning sensation during MRI. The ink used for black or dark brown tattooing may contain compounds of iron oxide that have ferromagnetic properties and may cause burning during MRI, especially if the design is in loop patterns [3]. The other pigments used for tattooing—namely carbon (black), titanium dioxide (white), copper phthalocyanine (blue, green), and indigoid (red)—did not seem to have ferromagnetic effects when tested with a magnet [3]. We wish to caution the medical community to consider potential problems with dark tattoos during MRI.

References

1. Tope WD, Shellock FG. Magnetic resonance imaging and permanent cosmetics (tattoos): survey of complications and adverse events. J Magn Reson Imaging 2002;15:180 -184[Medline]
2. Vahlensieck M. Tattoo related cutaneous inflammation (burn grade 1) in a mid field MR scanner. Eur Radiol2000; 10:197[Medline]
3. Kreidstein ML, Giguere D, Freiberg A. MRI interaction with tattoo pigments: case report, pathophysiology, and management. Plast Reconstr Surg 1997;99:1717 -1720[Medline]
4. Wagle WA, Smith M. Tattoo-induced skin burn during MR imaging. AJR 2000;174:1795[Free Full Text]

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