Unveiling the Temporal Aspect of MRI Tattoo Reactions: A Prospective Evaluation of a Newly-Acquired Tattoo with Multiple MRI Scans

Background: Over the past 30 years, painful reactions during magnetic resonance imaging (MRI) in tattooed individuals have been sporadically reported. These complications manifest as burning pain in tattooed skin areas, occasionally with swelling and redness, often leading to termination of the scanning. The exact cause is unclear, but iron oxide pigments in permanent make-up or elements in carbon black tattoos may play a role. Additionally, factors like tattoo age, design, and color may influence reactions. The existing literature lacks comprehensive evidence, leaving many questions unanswered. Case Report: We present the unique case of a young man who experienced recurring painful reactions in a recently applied black tattoo during multiple MRI scans. Despite the absence of ferrimagnetic ingredients in the tattoo ink, the patient reported intense burning sensations along with transient erythema and edema. Interestingly, the severity of these reactions gradually decreased over time, suggesting a time-dependent factor contributing to the problem. This finding highlights the potential influence of pigment particle density in the skin on the severity and risk of MRI interactions. We hypothesize that the painful sensations could be triggered by excitation of dermal C-fibers by conductive elements in the tattoo ink, likely carbon particles. Conclusions: Our case study highlights that MRI-induced tattoo reactions may gradually decrease over time. While MRI scans occasionally can cause transient reactions in tattoos, they do not result in permanent skin damage and remain a safe and essential diagnostic tool. Further research is needed to understand the mechanisms behind these reactions and explore preventive measures.