MRI susceptibility-related artifacts following prolonged use of silver-containing dressings

Rationale: Silver-containing dressings are widely used in postoperative and chronic wound care because of their antimicrobial properties. Although these dressings are generally considered compatible with magnetic resonance imaging (MRI) under standard conditions, prolonged use in chronic open wounds may be associated with local retention or deposition of silver-containing material. This could contribute to susceptibility-related signal loss or distortion on MRI and interfere with the evaluation of underlying anatomical structures. However, clinical evidence supporting this association remains limited, and a definitive causal relationship has not been established. Patient concerns: A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision. He had used silver-containing dressings intermittently for postoperative wound care over an 8-month period. Because of delayed wound healing and recurrent symptoms, pelvic MRI was performed to evaluate the cause. Diagnoses: MRI demonstrated extensive signal loss and distortion in the sacrococcygeal region, suggestive of susceptibility-related artifacts, which obscured anatomical structures and limited diagnostic assessment. After removal of wound-related material by debridement, follow-up MRI demonstrated a fistulous tract extending from the anal canal to the previous wound site. The patient was diagnosed with an anal fistula associated with a chronic nonhealing postoperative wound. Interventions: Given the possibility that wound-related or silver-containing dressing-associated material contributed to the MRI artifacts, wound debridement was performed. After the follow-up MRI clarified the fistulous tract, the patient underwent fistula surgery. Outcomes: Follow-up MRI after debridement showed near-complete reduction of the artifacts and allowed visualization of the fistulous tract. The patient underwent surgical treatment, and follow-up showed satisfactory wound healing. Lessons: Prolonged use of silver-containing dressings may be associated with retention or deposition of dressing-related material, which could represent a possible contributor to susceptibility-related MRI artifacts in selected patients. However, silver deposition was not directly confirmed by elemental analysis or susceptibility-sensitive MRI sequences, and alternative causes could not be completely excluded. Clinicians and radiologists should consider this potential source of imaging interference in patients with chronic wounds and a history of long-term silver dressing use. Careful wound assessment and removal of residual wound-related material before MRI may be helpful when artifact-related diagnostic interference is suspected.