OCTOBER 2013 • Vol. 2, Issue 4

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

Frank G. Shellock, Ph.D., FISMRM, FACC, FACSM
Adjunct Clinical Professor of Radiology and Medicine
Keck School of Medicine, University of Southern California

Director for MRI Studies of Biomimetic MicroElectronic Systems
National Science Foundation, Engineering Research Center
University of Southern California

Institute for Magnetic Resonance Safety, Education, and Research



"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."

(This article represents the views of its author only and does not reflect those of the International Society for Magnetic Resonance in Medicine and are not made with its authority or approval)
Cosmetics, including eye makeup, nail polishes, body lotions, hair loss concealers and others are frequently used to improve or enhance the appearance of the human body. Several reports have indicated that certain cosmetics, especially those containing iron oxide or “heavy metal particles”, can produce unwanted artifacts on magnetic resonance (MR) images (1-5). This information has mostly been limited to eye makeup (e.g., mascara, eye shadow, and eye liner) and restricted to MR systems operating at 1.5-Tesla or less.

Many other types of cosmetics may contain ingredients that cause artifacts on MR images and it is well known that artifacts are inherently larger in association with 3-Tesla MR systems (1, 6, 7). Artifacts may create issues if the area of interest is the same as where the cosmetic was applied or if its presence was unknown to the radiologist, thus, potentially causing it to be interpreted as pathology (1-5).

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.

Figure 1. Artifact testing of hair loss concealer. (Top left) Top Coverage Plus Bald Spot Eraser that underwent evaluation for MRI artifact size. (Bottom left) Before and after examples showing the hair loss concealer applied to an individual. (Top right) The hair loss concealer was applied to a 5-cm x 5-cm piece of white paper and allowed to dry for four hours. This paper was then attached to the surface of a copper-sulfate-filled phantom for the assessment of artifacts. (Bottom right) Note the substantial signal loss that extends below the surface of the copper-sulfate-filled phantom on the MR image (GRE sequence; TR 100 msec; TE 15 msec; flip angle 30°).

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.

Figure 2. The pillar-type, ferromagnetic detection system used in the investigation by Shellock and Karacozoff (8) to study the use of this device to identify implants and other objects.
(1) Escher KB, Shellock FG. Evaluation of MRI artifacts at 3-Tesla for 38 commonly used cosmetics. Magnetic Resonance Imaging 2013;31:778-782.
(2) Smith FW, Crosher GA. Mascara--an unsuspected cause of magnetic resonance
imaging artifact. Magn Reson Imaging. 1985;3:287-9.
(3) Weiss RA, Saint-Louis LA, Haik BG, McCord CD, Taveras JL. Mascara and eye-lining tattoos: MRI artifacts. Ann Ophthalmology 1989;21:129-131.
(4) Wright RM, Swietek PA, Simmons ML. Eye artifacts from mascara in MRI. AJNR Am
J Neuroradiol. 1985;6:652.
(5) Sacco D, Steiger DA, Bellon EM, Coleman PE, Haacke EM. Artifacts caused by cosmetics in MR imaging of the head. Am J Roentgenol 1987;148:1001-1004.
(6) Hargreaves BA, Worters PW, Pauly KB, Pauly JM, Kock KM, Gold GE. Metal-induced artifacts in MRI. AJR Am J Roentgenol. 2011;197:547-55.
(7) Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices: 2013 Edition. Biomedical Research Publishing Group, Los Angeles, 2013.
(8) Shellock FG, Karacozoff AM. Detection of implants and other objects using a ferromagnetic detection system: implications for patient screening prior to MRI. American Journal of Roentgenology 2013;201:720-725.
Dr. Shellock announces his new book "MRI Bioeffects, Safety, and Patient Management" which is a fundraiser for the Lupus Research Institute. Please go to: http://www.mrisafetybook.com/ for more information.