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Please Read! reprinted with permission from Dr. Shellock
Tattoos, Permanent Cosmetics, and Eye Makeup
Before undergoing an MR procedure, the patient
should be asked if he or she has ever had any type of permanent
coloring technique (i.e., tattooing) applied to any part of the
body. This includes cosmetic applications such as eyeliner, lip-liner,
lip coloring, as well as decorative designs.
This question is necessary because of the associated
imaging artifacts and, more importantly, because a small number
of patients (fewer than 10) have experienced transient skin irritation,
cutaneous swelling, or heating sensations at the site of the permanent
colorings in association with MR procedures. More recently, there
has been one anecdotal report of a patient undergoing MR imaging
who complained of a burning sensation at the site where a large
tattoo had been applied on his arm using a black pigment.
Investigation of the incidents related to patients
experiencing problems in relation to the presence of tattoos revealed
that there was a tendency for the problem to occur whenever pigments
that contained iron oxide or other similar ferromagnetic substance(s)
were used. This includes those pigments that are especially black
or blue in color.
Supposedly, certain ferrous pigments used for
the tattooing process can interact with the electromagnetic fields
used for MR procedures, producing the reported problems
A recent case report indicated that 24 year old
patient experienced a sudden burning pain at the site of a decorative
tattoo while undergoing an MR procedure on the lumbar spine using
a 1.5 T MR system. Swelling and erythema was resolved within 12
hours, with no evident permanent sequela. To permit completion of
the MR examination, an excision of the tattoed skin with primary
closure of the site was performed. Apparently, the tattoo pigment
used in this case was ferromagnetic, accounting for the symptoms
experienced by the patient.
Of note is that the authors of this report wrote,
"Theoretically, the application of a pressure dressing of the
tattoo may prevent any tissue distortion due to ferromagnetic pull."
However, there was not attempted for this patient. They also indicated,
"In some cases, removal of the tattoo may be the most practical
means of allowing MRI."
Kanal and Shellock commented on this report in
a letter to the editor, suggesting that the events were "rather
aggressive". Clearly the trauma, expense, and morbidity associated
with excision of the tattoo far exceed those which may be associated
with ferromagnetic tattoo interactions.
The demonstration of grossly detectable ferromagnetic
characteristics of a tattoo is not new and has been well-known for
over a decade. Certainly, the painful sensation experienced by the
patient could not be considered a serious adverse event nor warrant
the excision of the tattoo. Particularly in consideration of the
existence of other imaging modalities that could be used to assess
the lumbar spine (computed tomography, myelography, etc.).
Kanal and Shellock recommended the following procedures
to prevent potential problems associated with a similar incident:
(1) bandage the area with a pressure dressing and immobilize the
tattooed skin with sufficient force to prevent motion of the skin
upon exposure to the static magnetic field of the MR system; and
(2) in the very rare instance where a patient reports ferromagnetic
discomfort or pain, have the patient approach the MR system in a
manner to minimize both translational and rotational forces by orienting
the patient's tattoo parallel to the magnetic lines of force associated
with the MR system.
When one considers the many millions of clinical
MR procedures that have been conducted in patients over the past
15 years and that only a few individuals have had a minor, short-term
difficulty related to the presence of permanent coloring, it is
apparent that this problem has an extremely low rate of occurrence
and relatively insignificant consequences.
Any problem performing an MR procedure in a patient
that has a tattoo is unlikely to prevent the examination, since
the important diagnostic information that is provided by this imaging
modality is typically critical to the care of the patient.
If a patient with a tattoo requires an MR procedure,
the individual should be informed of the relatively minor risk associated
with the site of the permanent coloring application. In addition,
the patient should be requested to advise the MR operator regarding
any unusual sensations felt at the site of the tattoo during the
MR examination.
Patients with tattoos located on extremities or
peripheral sites should be positioned in the MR system to avoid
direct contact with the body coil or surface coils (e.g., foam rubber
pads may be placed in between the site of the tattoo and the coil)
to minimize the potential problem. Similar to other patients undergoing
MR procedures, patients with tattoos should be closely monitored
using visual and auditory means throughout the entire operation
of the MR system to ensure their safety.
With respect to eye makeup, there has been a report
of a patient that developed eye irritation when her makeup, which
contained ferromagnetic particles, became displaced from her eyelid
into her eye during exposure to the MR system. Therefore, it is
necessary to inform individuals with certain types of eye makeup
about the potential problems related to the presence of eye makeup
and request that they remove it (if appropriate) before undergoing
the MR procedure.
Tattoos, Permanent Cosmetics, and Eye Makeup References
Jackson JG, Acker JD. Permanent eyeliner and MR
imaging. Am J Roentgenol 1987;49:1080.
Kanal E, Shellock FG. MRI interaction with tattoo
pigments. Plastic and Reconstructive Surgery 1998;101:1150-1151.
Kreidstein ML, Giguere D, Friedberg A. MRI interaction
with tattoo pigments: Case report, pathophysiology, and management.
Plastic and Reconstructive Surgery 1997;99:1717-1720.
Lund G, Nelson JD, Wirtschafter JD, Williams PA.
Tattooing of eyelids: magnetic resonance imaging artifacts. Ophthalmic
Surgery 1986;17:550-553.
Sacco D, et al. Artifacts caused by cosmetics
in MR imaging of the head. Am J Roentgenol 1987;148:1001-1004.
Shellock FG. Guide to MR Procedures and Metallic
Objects: Update 1999. Fifth Edition, Lippincott Williams & Wilkins
Healthcare, Philadelphia, 1999.
Shellock FG, Kanal E. Magnetic Resonance: Bioeffects,
Safety, and Patient Management. Second Edition, Lippincott-Raven
Press, New York, 1996.
(c) 2001 by Shellock R & D Services, Inc.
and Frank G. Shellock, Ph.D. All Rights Reserved. All copyrights
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