Cognitive or cosmetic dysfunction?



Illustration 1.

The patient, a 57-year-old woman with recurrent deep vein thromboses, multiple second-trimester fetal losses, and persistent high-titer IgA anti–β2-glycoprotein I antibody, underwent magnetic resonance imaging (MRI) of the brain for the investigation of cognitive dysfunction. A midsagittal T1 fluid-attenuated inversion recovery image (A) and an axial T2 image (B) revealed abnormalities emanating from the frontal vertex in the midline (arrows) mimicking a saucerized defect in the subcutaneous fat extending to the calvarium. Upon further questioning, the patient stated that she had applied hair gel before the procedure; this was determined to be the cause of these artifacts. Hair styling products contain iron oxide and cobalt (McKinstry RC, Jarrett DY. Magnetic susceptibility artifacts on MRI: a hairy situation. AJR Am J Roentgenol 2004;182:532) (ferromagnetic compounds with high magnetic susceptibility), which can result in misregistration of the local magnetic field and signal loss in adjacent tissues. Similar cases as a result of eye makeup or tattoos have been reported (Sacco DC, Steiger DA, Bellon EM, Coleman PE, Haacke EM. Artifacts caused by cosmetics in MR imaging of the head. AJR Am J Roentgenol 1987;148:1001–4). Although radiologists are generally aware of these artifacts, rheumatologists may not be familiar with hair gel–induced MRI “cosmetic dysfunction.”