OCTOBER 2013 • Vol. 2, Issue 4

Hair Loss Concealer: Unusual MRI Artifacts and Positive Alarm on Ferromagnetic Detection System

A recent study conducted by Escher, et al. (1) involved investigating artifacts at 3-Tesla for thirty-eight different types of cosmetics. The findings indicated that, of the thirty-eight cosmetics studied, the following exhibited artifacts on MRI: two nail polishes; five eyeliners; three mascaras; three eye shadows; and one hair loss concealer. The artifact size ranged from small (eye shadow) to very large (hair loss concealer) and tended to be associated with the presence of iron oxide or other metal-based ingredient. Therefore, it was concluded that many commonly used cosmetics cause artifacts that could create issues for MRI procedures.

As part of the pre-MRI screening procedure, consideration should be given to patient management with regard to this information and a policy should be in place to prevent problems related to cosmetics. The policy may include advising patients before they arrive for MRI exams to thoroughly remove all cosmetics. Alternatively, it may be necessary to have makeup removal items available at the MRI facility to take off different types of cosmetics (e.g., nail polish remover).

In the case of the hair loss concealer (Top Coverage Plus Bald Spot Eraser, TC Plus
Liminova Inc., Rancho Santa Fe, CA) that underwent testing, substantial signal loss was associated with this product (Figure 1). The artifact was caused by the presence of iron oxide, which exists in a high concentration. Accordingly, if the brain is the area of interest for the MRI procedure, it is necessary for the patient to thoroughly wash the area where the hair loss concealer was applied in order to remove this product.

While it would be beneficial to identify a patient using hair loss concealer before performing MRI of the brain, the patient may be unwilling to divulge the use of this product and surely not aware of the artifact issue. Accordingly, if an MRI technologist or radiologist observes a large signal void mostly related to the surface of the scalp in a patient that does not have a neurological metallic implant, the possibility of hair loss concealer as being responsible for the artifact should be considered.

Another very interesting finding was that this particular hair loss concealer gave a positive alarm during testing using a ferromagnetic detection system (FMDS). Ferromagnetic detection systems have been utilized as part of the screening procedure for MRI with the primary intent of preventing accidents or other problems related to external ferromagnetic objects, (e.g., pocket knives, cell phones, hearing aids, etc.) (8). A recent study by Shellock and Karacozoff (8) reported that a certain ferromagnetic detection system (Ferroguard Screener, Metrasens, Lisle, IL; www.Metrasens.com) may be a useful tool to screen patients referred for MRI examinations that may have implanted or embedded items, such as biomedical implants and foreign bodies (Figure 2).

During additional investigation of the hair loss concealer it was noted that the Ferroguard Screener exhibited a positive finding for this product, which was related to the iron oxide ingredient. This finding has important implications for patient screening insofar as the presence of hair loss concealer may not be considered as the cause of the positive alarm when using an FMDS and, as such, MRI technologists will need to realize this possibility during the screening process and engage the patient in further questioning to determine if this is, indeed, the source of an alarm.