MRI in detecting facial cosmetic injectable fillers.
BACKGROUND
Despite being considered a non-invasive procedure, injections can cause adverse outcomes including infections, overfilling, asymmetry, foreign body granulomas, and reactions that lead to scarring. Complications may be associated with the procedure itself, the physician's technique, and/or the type of agent injected. In these instances, it is important to be able locate and identify the substance used. This study investigated the viability of using MRI to correctly identify injected substances, their symmetry of distribution, and related complications.


METHODS
Fourteen patients with suspected injectable filler complications were identified by our institution's plastic surgery service. All subjects were scanned with MRI, using highly specific face-oriented sequences at high resolution with small field of view and thin slices across the axial and coronal planes by T1 Dixon non-contrast, T2 Dixon, and T1 Dixon after gadolinium injection. Two independent and blinded radiologists evaluated the images and reported (1) the likely injected substance, (2) symmetry, and (3) complications. These radiological results were compared against clinical data provided by the plastic surgery service.


RESULTS
Ten patients (83 %) presented objective injectable complications: 4 had abscess, 4 granulomata, and 2 had allergic reactions to the injected substance. The Fleiss Kappa for inter-rater agreement on substances was 0.80. Asymmetry was identified in six patients (50 %) with a Kappa between radiology evaluators of 1. MRI characteristics of these common fillers are summarized in table form.


CONCLUSIONS
Given the growing awareness among referring physicians of the value of dedicated facial MRI, utilization of this imaging technique may lead to discovery of the injected substance's true identity, evaluation of symmetry and/or complications.
Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.|Department of Medical Imaging, Sackler Faculty of Medicine, Tel Aviv Universiy, Zeriffin, 70300, Israel.
Sigal
S
Tal
Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. maresky@gmail.com.|Department of Medical Imaging, Sackler Faculty of Medicine, Tel Aviv Universiy, Zeriffin, 70300, Israel. maresky@gmail.com.
Hillel S
HS
Maresky
Department of Radiology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Theodore
T
Bryan
Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ella
E
Ziv
Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dov
D
Klein
Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Assaf
A
Persitz
Plastic Surgery, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Lior
L
Heller
D000368:Aged; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000000981:diagnostic imaging; D005145:Face / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007279:Injections, Subcutaneous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D015595:Skin Aging / Q000187:drug effects*
D000067548:Dermal Fillers