title: MRI in the evaluation of facial dermal fillers in normal and complicated cases.
abstract: OBJECTIVE
  To ascertain by MRI the presence of filler injected into facial soft tissue and characterize complications by contrast enhancement.
  
  
  METHODS
  Nineteen volunteers without complications were initially investigated to study the MRI features of facial fillers. We then studied another 26 patients with clinically diagnosed filler-related complications using contrast-enhanced MRI. TSE-T1-weighted, TSE-T2-weighted, fat-saturated TSE-T2-weighted, and TIRM axial and coronal scans were performed in all patients, and contrast-enhanced fat-suppressed TSE-T1-weighted scans were performed in complicated patients, who were then treated with antibiotics. Patients with soft-tissue enhancement and those without enhancement but who did not respond to therapy underwent skin biopsy. Fisher's exact test was used for statistical analysis.
  
  
  RESULTS
  MRI identified and quantified the extent of fillers. Contrast enhancement was detected in 9/26 patients, and skin biopsy consistently showed inflammatory granulomatous reaction, whereas in 5/17 patients without contrast enhancement, biopsy showed no granulomas. Fisher's exact test showed significant correlation (p < 0.001) between subcutaneous contrast enhancement and granulomatous reaction. Cervical lymph node enlargement (longitudinal axis >10 mm) was found in 16 complicated patients (65 %; levels IA/IB/IIA/IIB).
  
  
  CONCLUSIONS
  MRI is a useful non-invasive tool for anatomical localization of facial dermal filler; IV gadolinium administration is advised in complicated cases for characterization of granulomatous reaction.
  
  
  CONCLUSIONS
  • MRI is a non-invasive tool for facial dermal filler detection and localization. • MRI-criteria to evaluate complicated/non-complicated cases after facial dermal filler injections are defined. • Contrast-enhanced MRI detects subcutaneous inflammatory granulomatous reaction due to dermal filler. • 65 % patients with filler-related complications showed lymph-node enlargement versus 31.5 % without complications. • Lymph node enlargement involved cervical levels (IA/IB/IIA/IIB) that drained treated facial areas.
authors.affiliation: Radiology Unit, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy, digirolamomarco@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Girolamo
authors.forename: Mauro
authors.initials: M
authors.lastname: Mattei
authors.forename: Alberto
authors.initials: A
authors.lastname: Signore
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Grippaudo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000008:administration & dosage*; D003287:Contrast Media; D003357:Cosmetic Techniques / Q000009:adverse effects*; D005145:Face / Q000473:pathology*; D005260:Female; D006099:Granuloma / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006571:Heterocyclic Compounds; D006801:Humans; D007089:Image Enhancement; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate