Jonathan A Kadouch1, Charlotte J Tutein Nolthenius2, Daniel J Kadouch3, Henk-Jan van der Woude4, Refaat B Karim5, Rick Hoekzema6. 1. Dr J.A. Kadouch is a resident, Division of Dermatology, Free University Medical Center, Amsterdam, Netherlands j.kadouch@vumc.nl. 2. Dr Tutein Nolthenius is a resident in a teaching hospital, Division of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands. 3. Dr D.J. Kadouch is a resident, Division of Dermatology, Academic Medical Center, Amsterdam, Netherlands. 4. Dr van der Woude is a radiologist in a teaching hospital, Division of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands. 5. Dr Karim is a plastic surgeon in private practice in Amstelveen, Netherlands. 6. Dr Hoekzema is the Head of the Division of Dermatology, Free University Medical Center and Academic Medical Center, Amsterdam, Netherlands.
Abstract
BACKGROUND: Soft-tissue fillers have become more prevalent for facial augmentation in the last 2 decades, even though complications of permanent fillers can be challenging to treat. An investigative imaging tool could aid in assessing the nature and extent of these complications when clinical findings are ambiguous. OBJECTIVES: The authors analyzed the value of magnetic resonance imaging (MRI) in the assessment of delayed-onset complications after injection of patients with permanent fillers. METHODS: Thirty-two patients with complications related to facial fillers were evaluated in this prospective cohort study. Their medical history was documented, and MRI was conducted before treatment of the complications. Radiologists were informed of the injection sites but were blinded to the results of other clinical evaluations. Levels of agreement between clinical and radiologic findings were calculated with the Jaccard similarity coefficient. RESULTS: A total of 107 site-specific clinicoradiologic evaluations were analyzed. The level of agreement was assessed as strong for deposits without complications and noninflammatory nodules (combined 85%), moderate for abscesses (60%), fair for low-grade inflammations (32%), and slight for migrations (9%). Results from the MRI examinations aided in subsequent treatment decisions in 11% of cases. CONCLUSIONS: Study results show that MRI may be useful for diagnosing complications associated with fillers that have migratory potential, for depiction of the extent of deposits before treatment, and for follow-up of low-grade inflammation and abscesses after surgery. LEVEL OF EVIDENCE: 3.
BACKGROUND: Soft-tissue fillers have become more prevalent for facial augmentation in the last 2 decades, even though complications of permanent fillers can be challenging to treat. An investigative imaging tool could aid in assessing the nature and extent of these complications when clinical findings are ambiguous. OBJECTIVES: The authors analyzed the value of magnetic resonance imaging (MRI) in the assessment of delayed-onset complications after injection of patients with permanent fillers. METHODS: Thirty-two patients with complications related to facial fillers were evaluated in this prospective cohort study. Their medical history was documented, and MRI was conducted before treatment of the complications. Radiologists were informed of the injection sites but were blinded to the results of other clinical evaluations. Levels of agreement between clinical and radiologic findings were calculated with the Jaccard similarity coefficient. RESULTS: A total of 107 site-specific clinicoradiologic evaluations were analyzed. The level of agreement was assessed as strong for deposits without complications and noninflammatory nodules (combined 85%), moderate for abscesses (60%), fair for low-grade inflammations (32%), and slight for migrations (9%). Results from the MRI examinations aided in subsequent treatment decisions in 11% of cases. CONCLUSIONS: Study results show that MRI may be useful for diagnosing complications associated with fillers that have migratory potential, for depiction of the extent of deposits before treatment, and for follow-up of low-grade inflammation and abscesses after surgery. LEVEL OF EVIDENCE: 3.
Authors: Sigal Tal; Hillel S Maresky; Theodore Bryan; Ella Ziv; Dov Klein; Assaf Persitz; Lior Heller Journal: Head Face Med Date: 2016-09-06 Impact factor: 2.151