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First-Degree Burns on MRI due to Nonferrous Tattoos

Charité Universitätsmedezin Berlin Berlin, Germany

 
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We report the occurrence of a patient receiving first-degree burns of the eyelids in the context of a cranial MRI investigation. The patient, a 25-year-old woman, had a narrow, permanent cosmetic tattoo on the bilateral upper eyelids (so-called permanent eyelid make-up) that was free of ferric oxide pigment. She was admitted to the ward in the context of the diagnostic assessment of a chronic inflammatory CNS disorder. During the 1.5-T cranial MRI data acquisition of a HASTE sequence (i.e., an early acquisition of scout images using the HASTE sequence), the patient indicated that she felt a burning sensation of the upper eyelids. On immediate interruption of the investigation, a brief clinical examination was initiated. A laterally accentuated erythema was found on the bilateral upper eyelids. The patient was transported to the ward, at which point there was evidence of upper eyelid edema.

The aforementioned changes were confirmed independently by the technical MRI assistant, the neuroradiologist, the ward physician, and the head nurse. The patient did not consent to photographic documentation.

On dismissal, 3 days after MRI, both edema and erythema were in spontaneous remission, documenting structural and functional restitutio ad integrum and a first-degree burn.

The manufacturer's certificate of analysis of the chemical characteristics of the tattoo components identified various heavy metals (e.g., lead, copper, zinc, chrome, arsenic, cadmium, barium, and mercury) but no ferric oxides. The manufacturer denies previous MRIassociated incidents.

This case underscores the fact that in singular cases of diagnostic MRI data acquisition a burn can occur due not only to ferric oxide pigments [1-6] but also to tattoos free of ferric oxides. The national metrology institute PTB (Physikalisch-Technische-Bundesanstalt, Berlin, Germany) identified the cause as originating in a locally induced electric current. This can, generically speaking, be induced by any metal (not just ferromagnetic metals) moving through a high-frequency magnetic field [2]. Material warming is a function of multiple parameters: the high-frequency impulse needed for the resonance, the specific heat coefficient of the material, the specific weight, the conductivity of the metal, the blood circulation, the ambient temperature, and the ventilation [7].

Although Tope and Shellock [4] reported that only 1.5% of patients with a permanent cosmetic tattoo (n = 135) experienced dysesthesia, the case we describe here shows that in singular cases first-degree burns can develop.

Because the ferric acid pigments are not necessarily the sole cause of noxious side effects as generally supposed, we suggest that the patient must be explicitly informed about the danger of such burns, even if the analysis certifies that the tattoo components are free of ferrous content. Furthermore, we suggest that a corresponding item be added to standardized MRI informed consent forms. Finally, in the case of insufficient diagnostic alternatives to MRI, sedative medication should be avoided and continuous visual and audio monitoring are mandatory to timely recognize hazardous side effects of cosmetic tattoos.

References

Top References

 

1. Carr JJ. Danger in performing MR imaging on women who have tattooed eyeliner or similar types of permanent cosmetic injections. AJR 1995; 165:1546 -1547[Medline]
2. Kreidstein ML, Giguere D, Freiberg A. MRI interaction with tattoo pigments: case report, pathophysiology, and management. Plast Reconstr Surg 1997; 99:1717 -1720[Medline]
3. Wagle WA, Smith M. Tattoo-induced skin burn during MR imaging. (letter) AJR 2000;174 : 1795[Free Full Text]
4. 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[CrossRef][Medline]
5. Ratnapalan S, Greenberg M, Armstrong D. Tattoos and MRI. (letter) AJR 2004; 183:541[Free Full Text]
6. Klitscher D, Blum J, Kreitner KF, Rommens PM. MRI-induced burns in tattooed patients: case report of a traumatic surgery patient [in German]. Unfallchirurg 2005;108 : 410-414[CrossRef][Medline]
7. Price RR. The AAPM/RSNA physics tutorial for residents: MR imaging safety considerations. Radiological Society of North America. RadioGraphics 1999;19 : 1641-1651[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Franiel, T. Articles by Klingebiel, R. Search for Related Content PubMed PubMed Citation Articles by Franiel, T. Articles by Klingebiel, R. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?