Do Tattoos Hurt During Mri
Sports Health. 2011 Sep; 3(5): 431–434.
Tattoo-Induced Pare "Burn" During Magnetic Resonance Imaging in a Professional Football Player
A Instance Report
Abstract
The authors present the case of a professional person football game histrion with an immediate and sustained cutaneous reaction ("burn") at the site of lower extremity tattoos that occurred during magnetic resonance imaging of the pelvis. The burn down was attributed to an electromagnetic reaction due to the ferromagnetic metallic compounds constitute in tattoo pigments, especially iron oxide—a reaction that has the potential to distort the field of image. These compounds can theoretically create an current that increases the local skin temperature, enough to cause a cutaneous burn. "At chance" tattoos are those with blackness paint or whatever other pigments containing iron oxide, as well as those with a blueprint that displays loops, big circular objects, or multiple adjacent points. Patients who develop this reaction may be treated prophylactically or symptomatically with a cold compress to assist with completion of the examination. Alternatively, a towel or cloth may be placed between the cutaneous torso parts in those patients who experience the typical reaction resulting from an electrical arc between two split cutaneous tattoos. This is likely an underreported upshot that merits mention in the sports medicine literature given the frequent occurrence of cosmetic tattoos in athletes requiring magnetic resonance imaging to diagnose a musculoskeletal injury. Equally in the present patient, no permanent sequelae have been noted in the literature. Therefore, patients who develop this reaction should be reassured that the reaction is only temporary.
Traditional and cosmetic tattoos accept been performed for thousands of years both in the United states and around the world. The Food and Drug Assistants considers the inks used in intradermal tattoos, including permanent makeup, to exist cosmetics, and it considers the pigments used in the inks to be colour additives requiring premarket blessing nether the federal Food, Drug, and Cosmetic Act.ten The administration, however, has not exercised its authority over tattoo inks or pigments because of other public wellness priorities and a previous lack of show of safety concerns. The actual practice of tattooing is regulated past local jurisdictions.
Magnetic resonance imaging (MRI) is a frequently used imaging modality for the assay of soft tissue injuries and is by and large considered a safe process. Well-nigh 70% of American football game players presenting to the 2010 National Football game League National Invitational Military camp (ie, NFL Scouting Combine) reported that they previously underwent MRI for a multifariousness of musculoskeletal injuries. Unfortunately, there is confusion in regard to the safety of an individual with a tattoo who must undergo this imaging modality, because of the presence of ferrous compounds present in the tattoo ink. Because that MRI uses magnetic energy to generate its images, the potential exists for an electromagnetic reaction to occur in the cutaneous expanse containing a tattoo. In that location have been documented case reports of tattoos causing not simply imaging artifacts just also minor cutaneous reactions.3,11,12
We present the case of a patient with an immediate and sustained cutaneous reaction at the site of lower extremity tattoos that occurred during MRI. This appears to be an emerging upshot given the expanding frequency of tattoos seen in amateur, every bit well equally professional, athletes. The patient was informed that the case would be submitted for publication, and he consented to the submission.
Case Report
A 24-twelvemonth-old white male professional person American football player in otherwise good general wellness, standing at 185.iv cm and weighing 108.4 kg, presented with discomfort in the right proximal hamstring. The patient was an outside linebacker who sustained a grade I proximal hamstring strain 2 months previously for which he underwent MRI without any complications. He reaggravated this injury afterward a hyperextension force to the right lower extremity.
Physical examination revealed normal neurologic and vascular findings in the lower extremity. His gait was antalgic, with the tendency to limit right human knee flexion during the swing stage. He had tenderness to palpation over the proximal origin of the hamstrings without any appreciable defect. He demonstrated pain with resisted knee flexion at 30°. The popliteal angle was 45° on the affected side, compared with 10° on the normal, contralateral limb. He had no other areas of tenderness and full, nontender range of motion of the correct hip. No dermatologic abnormalities or ecchymosis were noted; nevertheless, black-colored cosmetic tattoos were noted over the suprapatellar region of both knees (Effigy 1). Upon further inspection and questioning, it was revealed that he had multiple tattoos in various locations over his trunk that were obtained at different times throughout his life. Tattoos roofing the posterior upper arms were obtained in 2004 (left) and 2005 (right). The tattoos over the suprapatellar regions of both knees were obtained in 2008. His last tattoo, over the right flank, was obtained in 2009. All of his tattoos were fatigued by professional tattoo artists.
A, clinical paradigm of the patient's bilateral suprapatellar tattoos, which resulted in a localized peel burn during magnetic resonance imaging. B, close-upwardly image of left human knee farther demonstrating the nature of the tattoos.
Given the recurrent nature of the injury, the patient was referred for repeat MRI of the pelvis and thigh. He underwent preprocedural medical evaluation and preparation according to the facility'southward standard protocol. He was positioned supine in the 1.five-T MRI system feet first. MRI of the pelvis was performed using a body-phased assortment roll, with coronal images (large field of view, brusk repetition time, brusk echo time, and inversion recovery) likewise as transverse sequences (curt repetition time, short repeat time, and fast spin echo, and inversion recovery). Approximately five minutes subsequently initiation of the study, the patient began to experience a sudden called-for pain over the suprapatellar regions of both knees in the area of his tattoos. This sensation was localized to the knees and non experienced in the areas of the other tattoos. The patient notified the technician immediately, and the exam was interrupted and so that his knees could be inspected by the radiologist. A moisture towel was placed over and betwixt both knees, and the study was completed. The sensation continued; even so, information technology was present at a lower level that was tolerable. Afterwards completion of the study, the patient noted balmy swelling and erythema surrounding the tattoos over both knees. This superficial reaction resolved inside 12 hours without any evidence of permanent sequelae. Of annotation, the patient underwent four previous MRIs without any symptoms.
Discussion
The first report of an MRI-induced reaction to a patient's pare containing a tattoo was described by Kredstein et al in 1997.3 The patient in that report experienced sudden burning pain in the area of an abdominal tattoo, only in the presence of a static magnetic field upon entrance into the MRI suite. She ultimately underwent excision of the tattooed skin with primary closure of the site to permit completion of the MRI. The authors further confirmed a ferromagnetic holding of the tattoo pigment by documenting migration of the ellipsed skin toward a standard horseshoe magnet. They further studied the ferromagnetic properties of common tattoo pigments and showed that iron oxide–based pigments (most commonly black and brown) were displaced by a magnetic field, whereas carbon-, titanium-, and copper-based pigments were unaffected. Kanal and Shellock2 responded to this report by recommending that physicians consider placing an water ice pack or a cold compress on the tattoo earlier magnetic resonance examination and to leave information technology in identify until completion. They likewise recommended a pressure dressing to foreclose any tissue distortion. Of form, these conservative measures should exist tried before any invasive intervention, such as resection of the tattoo-containing skin.
Following the initial report described above, 2 other cases of cutaneous burns sustained by MRI were described in 2000.xi,12 One patient had a large tattoo (20 × 10 cm) of a dragon with "vivid colors and several loops of the tail and neck." It has been proposed that tattoos containing electrically conductive fabric that are applied to the dermis in a loop pattern are those virtually at risk for a cutaneous reaction. These particular tattoos have the potential to induce an electric current and thus fire the pare following the radiofrequency pulse of the MRI process.three Perhaps the combination of the size, ferromagnetic pigment, and loops of the tattoo caused the start-degree burn noted in this reported patient. The second patient sustained a second-degree burn in the right deltoid, in the region of a tattoo consisting of 2 jet-blackness thunderbolts encircling a Chinese symbol.12 Interestingly, the skin reaction occurred only over and surrounding the thunderbolts while sparing the key symbol. The supplier of the tattoo ink was contacted, and information technology was discovered that the nighttime tattoo ink contained high concentrations of atomic number 26 oxide, which has been shown to be highly ferromagnetic.iii
In 2002, Tope and Shellock9 performed a survey of individuals with tattoos in an endeavour to determine the incidence of complications and adverse events associated with MRI in the presence of a corrective tattoo. They identified 135 patients from 1032 surveys who underwent MRI after having permanent cosmetic tattoos applied. Two (1.5%) reported adverse events, which consisted of a "tingling" and "burning" sensation that resolved upon written report completion. Both women had blue-black paint colors for periorbital tattoos and had undergone MRI of the cervical spine. 5 (half-dozen%) inside this population had previously been denied MRI because of their cosmetic tattoos. Every bit a effect of the findings and the small number of case reports published, the authors recommended that patients with tattoos be granted permission to undergo MRI with close ascertainment.
Thermal injuries during MRI procedures have been described, mainly associated with monitoring systems including sensors, cables, or other foreign objects placed on the patient's skin.viii These injuries are thought to ascend from currents induced inside the conductive objects by the MRI coils, creating heat and eventually burns. The demonstration of grossly detectable ferromagnetic characteristics of the tattoos and cosmetics has been described in various journals.one,4,half dozen,13 These cases have been manifested primarily as image distortion in the area of interest due to a nearby tattoo. MRI involves the utilise of a stiff magnetic field to obtain images of structures within the trunk. The metallic compounds found in tattoo pigments, particularly iron oxide, distort that field. These compounds can theoretically create an electric electric current that increases the local skin temperature, plenty to cause a cutaneous burn down. Simple loops of conductive material have been shown to result in the induction of a large and potentially hazardous voltage in the imaging organization.5 It is highly conceivable that the loop-shaped tattoos in the patient carried a level of voltage significant enough to cause a burn. Alternatively, an arc may have been created from one human knee to the other given the symmetrical nature of the 2 tattoos and the lack of any cutaneous reaction in the patient's other tattoos. Self-resonance of such a loop may add greatly to hazards by increasing the constructive coupling to the radio frequency transmitter. We contacted the professional tattoo creative person who applied the histrion's tattoo and, subsequently, the tattoo ink distributor to determine the chemic composition of the black ink that was used. The tattoo ink supplier is based in Japan and could not be contacted, nor were we able to obtain the material safety data canvass or a list of the chemical components.
In consideration of the previous literature pertaining to MRI of patients with cutaneous tattoos, Shellockseven recommended the post-obit patient management guidelines:
—The screening form used for patients should include a question to identify the presence of permanent cosmetics or decorative tattoos.
—Earlier undergoing an MR procedure, the patient should be asked if he or she had a permanent coloring technique (ie, tattooing) applied to any part of the body. This includes cosmetic applications such equally eyeliner, lip-liner, lip coloring, too as decorative designs.
—The patient should be informed of the risks associated with the site of the tattoo.
—The patient should be advised to immediately inform the MRI technologist regarding any unusual sensation felt at the site of the tattoo in association with the MR procedure.
—The patient should be closely monitored using visual and auditory ways throughout the operation of the MR system to ensure safety.
—As a precautionary measure, a common cold compress (eg, wet washcloth) may be applied to the tattoo site during the MR process.
In summary, the patient with a corrective tattoo should be permitted to undergo MRI despite the rare possibility of a cutaneous reaction manifested most commonly as a depression-grade fire. Information technology is, all the same, important to identify tattoos that are "at hazard," such equally those with black pigment or any other pigments containing iron oxide, besides equally those with a design that displays loops, large round objects, or multiple next points. These patients may be treated prophylactically or symptomatically with a cold compress to assistance with completion of the examination. Alternatively, a towel or fabric may exist placed betwixt the cutaneous body parts in those patients who experience the typical reaction resulting from an electrical arc between two split up cutaneous tattoos.
Nosotros present the case of a National Football League football game role player who experienced burning hurting in the areas of his cosmetic tattoos, which was not responsive to the placement of interpositional material between each knee that had the tattoos. This is likely an underreported issue that merits mention in the sports medicine literature given the frequent occurrence of cosmetic tattoos in athletes requiring MRI to diagnose a musculoskeletal injury. No permanent sequelae have been noted. Therefore, patients who develop this reaction should be reassured that the reaction is but temporary.
References
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445217/
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