Case Report: MRI-induced soft tissue pain: incidental finding of a 15-year-old foreign body

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BMJ Case Rep. 2013; 2013: bcr2012008275.

Published online 2013 Feb 15. doi: 10.1136/bcr-2012-008275

Case Report

,¹,² and ³

Author information Copyright and License information Disclaimer

We present the case of an 82-year-old woman who developed intense right middle finger pain during MRI scan This alerted the clinical team to the incidental finding of a 15-year-old metallic foreign body in the distal phalanx of the right middle finger. This case report is a reminder that the responsible clinician should be vigilant when screening for metallic foreign body on completion of the MRI checklist, and should adopt a low threshold for plain imaging prior to MRI.

The presence of foreign body in the gastrointestinal tract,¹ foot² and eye³ through ingestion or trauma is well reported in the literature. Foreign body in the digits without the patient being aware of it appears to be much rarer. A literature review of PubMed using keywords incidental findings, metallic, foreign body and finger/hand did not reveal a single case report. Findings due to traumatic injuries have been reported but involved prior suspicion with further referral. The presentation described here is rare and serves as a reminder that current MRI checklists are not perfect, and should alert the clinician to medical history or behaviour that may suggest a risk of metallic foreign body presence.

A fully compos-mentis 82-year-old woman was being investigated with MRI for myelomatous deposits of the thoracic and lumbar vertebrae when she suddenly developed intense right middle finger pain during the scan. Prior to the scan, the patient filled out a routine MRI patient safety questionnaire which did not reveal any apparent contraindication to MRI. Following the MRI scan, an examination of the finger was carried out. There was no obvious sensory-motor deficit, and no soft tissue or joint pathology was palpable. A plain radiograph of the right hand revealed a 2 cm metallic spike on the ulnar aspect of the right middle finger distal phalanx (). It is thought that the ferrous nature of the metallic spike caused it to vibrate under the influence of the MRI scan’s magnetic field, leading to finger pain. The patient was then referred to the plastic surgery team who removed the foreign body under local anaesthetic. She made an uneventful recovery with no functional or tissue loss.

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x-Ray scan demonstrating a linear metallic foreign body in the right middle finger of an 82-year-old woman.

On subsequent questioning the patient recalled that she sustained a gardening injury 15 years ago when a metal spike broke off in her finger. She presented to the local general practitioner who prescribed antibiotics but she was not referred onwards for further management. The pain settled and the spike remained dormant and asymptomatic.

Current practises within the National Health Service (NHS) require patients to fill out an MRI screening questionnaire which asks patients about any prior surgery, foreign body injuries, the presence of a medical device or implant (aneurysm clips, pacemakers, mechanical valves) in addition to other contraindications related to pregnancy/breast feeding and anthropological factors.⁴

Screening questionnaires rely on the patient or carer’s knowledge, but, as demonstrated in this case report, this is not always reliable. This becomes more problematic when considering groups of patients who may not be fully compliant with the screening process. Examples of these include children with swallowed foreign bodies or objects placed in the nasal/ear canal without the parent or guardian being aware, or elderly patients with cognitive impairment whose medical history may not be available or known to the radiology department.

Metallic foreign bodies may present a hazard to the patient particularly if located in potentially dangerous areas of the body such as near viscous or neurovascular structure. The strong magnetic fields encountered in MRI may cause the object to migrate in an unpredictable manner.⁵ The seriousness of the risk depends on the ferromagnetic characteristics of the foreign body, its location and the strength of the MR magnetic fields.⁶ Most modern MRI system use static magnetic field strengths beyond 3.0 tesla which can have fatal effects on patients with contraindicating metallic foreign bodies. Previously reported incidents include intraocular metallic foreign bodies resulting in severe hyphema,⁷ blindness,⁸ death caused by torquing of an aneurysm clip,⁹ and five deaths related to inadvertent scanning of patients with cardiac pacemakers.¹⁰

This case report is a reminder that the responsible clinician should be vigilant when screening for metallic foreign body on completion of the MRI checklist, and should adopt a low threshold for plain radiography prior to MRI.

Learning points

• Incidental findings of metallic foreign body during MRI scan have been reported in the literature.

• The consequences of incidental foreign body detection during MRI scan can range from negligible to death.

• MRI checklists provide a reminder of the conditions that must be screened.

• It is the clinicians responsibility to ensure that the contraindications to MRI scanning has been adequately screened.

• A low threshold for plain radiography prior to MRI, particularly in the presence of behaviour that risks foreign body injury, should be adopted.

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

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MRI and low back pain: MedlinePlus Medical Encyclopedia

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Back pain and sciatica are common health complaints. Almost everyone has back pain at some time in their life. Most of the time, the exact cause of the pain can’t be found.

An MRI scan is an imaging test that creates detailed pictures of the soft tissue around the spine.

DANGER SIGNS AND BACK PAIN

Both you and your health care provider may be worried that something serious is causing your low back pain. Could your pain be caused by cancer or infection in your spine? How does your provider know for sure?

You will likely need an MRI right away if you have warning signs of a more serious cause of back pain:

• Cannot pass urine or stools
• Cannot control your urine or stools
• Difficulty with walking and balance
• Back pain that is severe in children
• Fever
• History of cancer
• Other signs or symptoms of cancer
• Recent serious fall or injury
• Back pain that is very severe, and not even pain pills from your provider help
• One leg feels numb or weak and it is getting worse

If you have low back pain but none of the warning signs just mentioned, having an MRI won’t lead to better treatment, better pain relief, or a quicker return to activities.

You and your provider may want to wait before having an MRI. If the pain does not get better or becomes worse, your provider will likely order one.

Keep in mind that:

• Most of the time, back and neck pain are not caused by a serious medical problem or injury.
• Low back or neck pain often gets better on its own with time.

An MRI scan creates detailed pictures of your spine. It can pick up most injuries that you have had in your spine or changes that happen with aging. Even small problems or changes that are not the cause of your current back pain are picked up. These findings rarely change how your provider first treats you. But they can lead to:

• Your provider ordering more tests that you may not really need.
• You’re worrying about your health and your back even more. If these worries cause you not to exercise, this may cause your back to take longer to heal.
• Treatment that you don’t need, especially for changes that occur naturally as you age.

MRI SCAN RISKS

In rare cases, the contrast (dye) used with MRI scans can cause severe allergic reactions or damage to your kidneys.

The strong magnetic fields created during an MRI can cause heart pacemakers and other implants not to work as well. Newer pacemakers can be MRI compatible. Check with your cardiologist, and tell the MRI technologist that your pacemaker is MRI compatible.

An MRI scan can also cause a piece of metal inside your body to move. Before having an MRI, tell the technologist about any metal objects that you have in your body.

Pregnant women should not have MRI scans.

Backache – MRI; Low back pain – MRI; Lumbar pain – MRI; Back strain – MRI; Lumbar radiculopathy – MRI; Herniated intervertebral disk – MRI; Prolapsed intervertebral disk – MRI; Slipped disk – MRI; Ruptured disk – MRI; Herniated nucleus pulposus – MRI; Spinal stenosis – MRI; Degenerative spine disease – MRI

Brooks MK, Mazzie JP, Ortiz AO. Degenerative disease. In: Haaga JR, Boll DT, eds. CT and MRI of the Whole Body. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 29.

Joyce AA, Isaac Z. Low back pain. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 81.

Mazur MD, Shah LM, Schmidt MH. Assessment of spinal imaging. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 274.

Masdeu JC, Ajtai B, Faridar A. Structural imaging using magnetic resonance imaging and computed tomography. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 40.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Headache after MRI 🚩 can a head hurt after MRI

Magnetic resonance imaging does not have a negative impact on human health. Headache after MRI occurs as a consequence of the individual characteristics of the patient. The method is based on the use of a magnetic field, people encounter this physical force in everyday life without experiencing discomfort.

In the process of scanning, the position of hydrogen atoms in the water molecules contained in the cells changes. The phenomenon of magnetic resonance does not affect the state of living tissues and disappears without a trace after the termination of the induction field.

A series of layer-by-layer images of the brain in the axial plane

MRI allows obtaining images of thin sections of the area under consideration at a given depth, which contributes to the accuracy of diagnosing pathological processes occurring in areas that are difficult to study. Scanning is done in sagittal, frontal and axial projections, layered images are sent to a computer monitor. If necessary, the doctor reconstructs a 3D model of the area of ​​interest, which visualizes the slightest changes in the shape, size, structure of anatomical formations.

Can I have a headache after an MRI?

There are many conflicting opinions on the Internet about the procedure of magnetic resonance imaging and the side effects of tomography. People are interested in whether a head can hurt after an MRI, how to avoid it, how harmful scanning is for health. The sensations that arise during the diagnostic procedure are sometimes uncomfortable, but absolutely safe for humans. Cephalgia (severe, prolonged headache) is often the result of insomnia, lack of rest, and drinking disorders.

If indicated, contrast enhancement is used to increase the information content of the study. The patient is injected intravenously with a solution of gadolinium, which is excreted from the body with urine and feces after 1-2 days. Vascular pathologies, accompanied by a violation of the permeability of the capillary walls, cause a migraine attack, weakness and nausea.

The causes of pain after MRI can be jumps in blood pressure (BP). Nervousness and tension experienced during the study lead to an increase in the level of adrenaline in the blood. The result is a short-term increase in blood pressure, a spasm of blood vessels is possible.

Claustrophobic patients experience stress when moving the table into the confined space of the CT tube. Fear and a feeling of lack of oxygen cause cephalalgia and dizziness.

People who are prone to migraines may experience discomfort that worsens after an MRI. The reason for the increase in pain is the stressful situation that an unprepared patient finds himself in during the procedure.

Pathologies of the cervical spine, decreased patency of the main vessels cause deterioration of the patient’s well-being while maintaining a motionless body position for 15-30 minutes. Pain occurs when oxygen supply to intracranial (intracranial) structures is disturbed, in case of difficulty in the outflow of venous blood.

Cephalgia after MRI may be a sign of:

• tumor processes in the brain;
• vascular pathologies;
• inflammatory and degenerative phenomena in cerebral structures;
• osteochondrosis;
• infectious diseases.

After an MRI of the brain, pain occurs as a result of an existing pathology. Cephalgia may serve as a reason for additional examination of the patient.

Neoplasm of the pituitary gland on sagittal magnetic resonance imaging

How long does the headache last after MRI?

Discomfort occurs during the procedure or within 1.5 hours after the end of the scan. The duration of the attack depends on the factors that provoked the development of cephalalgia.

According to patients, headaches after MRI last from 1-2 hours to 1-1.5 days. With objective reasons for the development of the syndrome (cervical osteochondrosis), the malaise disappears after an hour and a half. In cases where pain is the result of anxiety and suspiciousness of the patient, the duration of the attack depends on the level of stress. Improvement of well-being occurs with the normalization of the psycho-emotional state.

Severe pain lasting more than 24 hours is not a consequence of magnetic resonance imaging and is a reason for seeking medical help.

What should I do if I have a headache after an MRI?

Compliance with the restrictions on magnetic resonance imaging and following the recommendations of a specialist can prevent the development of cephalalgia during scanning.

Patients with claustrophobia and people who have a strong fear of MRI should tell the doctor about their concerns. It is possible to coordinate with the doctor the use of sedatives before the procedure.

It is advisable to have a snack before the contrast MRI (40 minutes before the start of the scan). With severe pain syndrome, the doctor may recommend taking analgesics and antispasmodics before the examination to stop the attack.

If cephalalgia has arisen as a result of cerebrovascular accident in osteochondrosis of the upper spine, a light massage of the back of the neck helps. At home, you should lie down, using a comfortable pillow, it is better to turn off the light in the room.

Disc herniation between the bodies of the 6th and 7th vertebrae in the cervical region on an MRI image in the sagittal projection

Do not recommend if you have a headache after an MRI, watch TV for a long time, work at a computer, engage in physical labor. Rest, drinking regimen and, if necessary, analgesics will help to get rid of the negative effects of scanning.

In case of a prolonged attack of headache, you should consult a doctor, perhaps the cause of cephalalgia was an underlying or concomitant disease.

Clinic “Magnit” offers a free telephone consultation, where the radiologist will tell you about the features of the MRI procedure. You can sign up for diagnostics by calling +7 (812) 407-32-31.

MRI of the knee joint what shows 🚩 indications and contraindications

MRI is a high-precision non-invasive examination based on the phenomenon of magnetic resonance.

Its essence lies in the fact that the nuclei of chemical elements in any tissues of the body can be represented as magnets rapidly rotating around their axis. If these nuclei are placed in an external magnetic field, then their axes of rotation are displaced, while absorbing part of the energy of the radio wave (the resonance effect). After the termination of the action of the external field, the nuclei of atoms take their original position (relax). The energy accumulated in this case is released in the form of electromagnetic oscillations, which can be detected by special equipment.

In medical tomographs, the resonance of hydrogen protons, which are part of the water molecule, is recorded. Due to the fact that this method is very sensitive even to slight changes in hydrogen concentration, it makes it possible not only to visualize tissues, but also to distinguish their normal structure from pathology.

How MRI of the knee joint is done

When examining the knee joint, it is important to consider that it has a very complex structure, including:

• epiphyses of the femur and tibia;
• muscles attached at the articulation;
• tendons and ligaments that provide movement in the joint;
• menisci and cartilaginous surfaces;
• synovial fluid.

Anterior view of the knee joint

To determine the cause of the joint dysfunction, it is necessary to carefully study the state of all these tissues. Even the smallest damage to any of them can significantly affect the function of the entire lower limb.

MRI accurately visualizes all degrees of cartilage changes from swelling to thinning, fibrillation and cracking. The condition of the subcartilaginous bone tissue, changes in the menisci, inflammation of the synovial membrane, and so on are assessed.

Calculation of the total volume of the affected cartilage and altered bone areas is possible, the condition of the cruciate ligaments is assessed.

MRI of the knee joint – indications

One of the main causes of disability for the active part of people is diseases of the joints. The popularization of complex sports leads to an increase in the number of injuries and orthopedic problems that occur already at a young age. Therefore, it is so important that their diagnosis is safe, accurate and as early as possible.

The method of magnetic resonance imaging fully meets these requirements.

An MRI is usually done after consultation with an orthopedic doctor, who performs special tests and makes a preliminary diagnosis. Most often, a tomogram is recommended in the following cases:

• traumatic injuries;
• preparation for surgery;
• signs of joint inflammation;
• suspicion of dystrophic changes;
• congenital developmental anomalies;
• the need to exclude tumors, metastases;
• doubtful data obtained during ultrasound, CT or radiography.

The most common form of articular pathology is osteoarthritis. This is a disease in which the entire joint is involved in the pathological process, including the subchondral portion of the bone, capsule, ligaments, synovial membrane, and periarticular muscles.

Gonarthrosis

This is osteoarthritis of the knee joint. The disease usually develops so imperceptibly that the patient finds it difficult to indicate the duration of the disease. There are periodic crunching during flexion, episodic dull pain after a pronounced and prolonged load on the joint, which quickly disappear after its termination. Gradually, their intensity increases, any load is already poorly tolerated, pain can appear at night.

Clinical manifestations of gonarthrosis usually begin at an older age, after 40-50 years, in women more often during menopause. It can be:

1. Primary – degeneration of initially intact articular surfaces. Usually associated with excessive overload of the knee.
2. Secondary – the pathology develops after trauma, inflammation, vascular or metabolic disorders.

In some cases, there is a combination of several etiological factors at once. Therefore, the main reason is the discrepancy between the load and the ability of the joint to withstand it.

Cartilage changes in osteoarthritis are similar to those that occur with aging. They are based on a change in the metabolic processes in the articular cartilage and a decrease in the content of its main component – proteoglycans. A decrease in their number leads to shrinkage and degeneration of cartilage tissue.

But with age-related processes, degeneration develops very gradually and does not lead to pronounced disturbances in the structure of nearby tissues. In the case of osteoarthritis, the pathology progresses much faster, has an onset at an earlier age, is combined with a change in the articular surfaces of the bones and the synoviocapsular apparatus. This makes it possible to distinguish gonarthrosis from senile changes and distinguish it as an independent disease.

MRI shows all stages of this process. On the tomogram, an effusion of synovial fluid and a subchondral bone cyst are determined in osteoarthritis of the knee joint.

First, the surface of the cartilage becomes uneven as it loses its firmness and elasticity. Further, it becomes less compact, is divided into separate fibers, exposing the area of ​​the underlying bone. Fragments can separate from the cartilage and get inside the joint, this phenomenon is called “articular mice”. In case of their contact and compression between the articular surfaces, a person experiences a sudden sharp pain. With some specific displacement in the knee, the “articular mouse” changes its position and the pain ends as suddenly as it began.

Frontal MRI of the knee joint

All these changes are most pronounced in the middle part of the articular surface, since it is more heavily loaded. A decrease in the elasticity of cartilage leads to the fact that it no longer protects the underlying bone, osteosclerosis is formed. It is also possible the appearance of cysts that open, forming bone erosion. On the lateral sections of the articular surfaces, the cartilage grows compensatory and is replaced by bone tissue – osteophytes are formed.

In the absence of timely treatment, a fibrous change in the synovial membrane and joint capsule occurs in the future, which significantly limits its function.

Juvenile idiopathic arthritis

This is a chronic inflammatory disease that develops in children under 16 years of age.

Accompanied by damage to the joints, often the knees. It can lead to irreversible destruction of cartilage and subchondral bone, up to subsequent disability.

The effectiveness of treatment directly depends on the possibility of early diagnosis (before bone erosions form) and the correct assessment of the degree of activity of the process.

An important feature of this disease is that about 70% of patients with early juvenile arthritis have no visible changes on radiographs. That is, if a child has a knee pain without visible changes on a conventional x-ray, it is better not to postpone and get an MRI, and not hope that it will go away on its own with time. Otherwise, you can miss the time needed to stop the process.

In this case, the advantage of MRI is that it makes it possible to assess the state of the synovial membrane. Most often, these are signs of synovitis in the form of the presence of fluid in the joint cavity, thickening of the synovial membrane.

It is important that, based on the analysis of the thickness of the synovial membrane and the volume of the effusion, it is possible to distinguish between an active process and a remission stage. This radically changes the tactics of treatment.

Baker’s cyst

Formed when the synovial sac is stretched as a result of trauma and inflammation. The cyst is filled with fluid and communicates with the joint cavity.

Initially visible only on MRI. With progression, it can be visually determined as a rounded dense formation in the popliteal region. At this stage, it can already cause pain during physical exertion and discomfort when bending the leg at the knee.

MRI of the knee joint shows the presence of a Baker’s cyst in the popliteal fossa (indicated by an arrow)

It may regress until it disappears completely, but subject to timely diagnosis and treatment. With its prolonged existence, the contents of the cyst harden, an adhesive process is formed. Its rupture is possible, leading to the appearance of acute pain, swelling in the popliteal fossa and the lower leg area. In this case, MRI is of particular importance, which makes it possible to carry out differential diagnostics with other pathologies.

Contraindications for MRI of the knee joint

The main limitations are associated with the presence of non-removable metal structures and foreign bodies in the body.

Based on their properties, a distinction is made between:

1. Ferromagnetics. They have their own magnetization and, getting into a powerful external magnetic field, can behave unpredictably. These include iron, nickel, cobalt, some alloys. Conducting an MRI if they are present in the body is prohibited.
2. Paramagnets. In the absence of an external magnetic field, they do not have magnetic properties. For example, titanium, platinum. They do not pose a danger, but can interfere if they are in the study area.

The final decision is made by the doctor after examining the documents describing the composition of the product.

Absolute contraindication for MRI is:

• presence of electronic devices – pacemaker, cochlear implant, insulin pump and others;
• first trimester of pregnancy;
• severe claustrophobia.

Our medical center does not examine children under the age of 5, parents need to go to a specialized children’s institution for an MRI of the knee joint under anesthesia. With a weight of more than 150 kg, MRI of the knee joint is also difficult due to the design features of the tomograph.

Preparing for an MRI of the knee

No special preparation is required, you can get to the tomography procedure at our medical center on the day of the appointment.

Before starting the tomography, you will be asked to remove all accessories and items of clothing containing metal, remove bank and other magnetic cards.

Be sure to provide your doctor with your medical history and previous test results. This will allow you to pay special attention to controversial issues, to choose the optimal protocol for the procedure.

How long does an MRI of the knee joint take?

The examination takes about 20 minutes. The patient is placed on a movable table that moves inside a magnet. The doctor at the time of the procedure is in the next room, but can maintain contact through the intercom, monitor the patient on the monitor.

A comfortable temperature and lighting are created inside the scanner. For better relaxation, headphones with pleasant music are offered. Immediately after the examination, you can return to the usual rhythm of life.

Deciphering MRI of the knee joint

Doctors with more than 7 years of experience deal with the description of images at the DiMagnit Medical Center. Our doctors specialize in MRI diagnostics, so their conclusions can be trusted.

The MRI technique can reveal the earliest changes in various joint structures. For example, it is indispensable in assessing the condition of the menisci. The degree of their change on MRI:

• 0 degree – normal condition of the meniscus;
• I degree – in the body of the meniscus there is a focal signal of increased intensity, which does not yet reach the edge of the meniscus;
• II degree – the appearance in the meniscus of a linear signal of increased intensity, not reaching its edges;
• III degree – the signal of increased intensity reaches the extreme part of the meniscus.

Meniscus rupture is indicated only by grade III changes.

The image shows a cruciate ligament and meniscus tear due to a knee injury.

The shape of the meniscus is also important for diagnosis. Normally, it has the shape of a butterfly in a certain plane. Any deviations may indicate a possible rupture.

Damage to the meniscus is often detected on MRI at the stage when a person has no significant complaints, such cases are not uncommon in aged patients.

MRI or CT of the knee – which is better?

The two examination methods differ fundamentally in that CT uses X-rays and MRI uses a safe magnetic field. Due to the presence of radiation exposure, doctors recommend not to conduct CT more than 2 times a year. The number of MRI sessions is not limited.

Initial soft tissue changes may not be visible on CT, so early diagnosis is unreliable. In this case, MRI is more informative, which makes it possible to identify the disease at the very initial stage.