Susceptibility-weighted imaging findings in a patient with systemic cobalt toxicity

Volume 128, May 2026, 110624

Author links open overlay panelRahul Monga a, Earn Chun Christabel Lee a, Kelly Johnson-Arbor bShow moreAbstractIntroduction

Systemic manifestations of cobalt toxicity include neurological, cardiac, and endocrine dysfunction. Neuroimaging findings in patients with cobalt intoxication are not well characterized.

Case summary

A 45-year-old woman developed bilateral sensorineural hearing loss after undergoing revision total hip arthroplasty and was subsequently diagnosed with cobalt toxicity. She underwent a second revision total hip arthroplasty, but her hearing loss persisted. As part of her otolaryngology evaluation, magnetic resonance imaging of the internal auditory canals was performed. Susceptibility-weighted imaging sequences on magnetic resonance imaging revealed increased mineralization in the basal ganglia and midbrain.

Discussion

Susceptibility-weighted imaging, which uses magnetic properties of tissues to enhance imaging, can detect mineral deposition in the brain. Since cobalt is magnetic, its brain deposition may be identified on susceptibility-weighted imaging, but the clinical implications of this are unclear.

Conclusion

Magnetic resonance imaging abnormalities, including mineralization on susceptibility-weighted imaging sequences, may occur in patients with systemic cobalt toxicity. Further research efforts may clarify the clinical significance of these abnormalities in cobalt-poisoned individuals.

Introduction

Cobalt toxicity is associated with neurological, cardiac, and endocrine impairments. Despite its association with neurological dysfunction, there are few reports of central nervous system radiographic abnormalities in patients with systemic cobalt toxicity. This brief report illustrates a unique brain magnetic resonance imaging (MRI) finding in a patient with systemic cobalt toxicity related to an orthopedic implant.

Access through your organization

Check access to the full text by signing in through your organization.

Access through your organizationSection snippetsCase report

A 45-year-old woman with a history of congenital hip dysplasia developed bilateral hearing loss, weight loss, and hair loss, five months after undergoing unilateral revision total hip arthroplasty. Audiometry testing revealed mild sloping to moderately-severe sensorineural hearing loss bilaterally, and plasma assays for cobalt (991.1 μg/L, range 0–0.9 μg/L) and chromium (72.5 μg/L, range 0.2–4.8 μg/L) were markedly elevated. After the diagnosis of systemic cobalt toxicity was established, the

Conclusion

Neurotoxicity, including sensorineural hearing loss, is a common manifestation of systemic cobalt intoxication. In patients with cobalt toxicity, neuroimaging may reveal abnormalities, including hypometabolism on PET imaging, and hypointensity indicating increased mineralization on MRI SWI sequences. The ferromagnetic properties of cobalt, in addition to its chemical and physical similarities to iron, suggest that SWI may be a useful technique for the assessment of cobalt deposition in the

Funding/grant support

None.

CRediT authorship contribution statement

Rahul Monga: Writing – review & editing, Visualization. Earn Chun Christabel Lee: Writing – review & editing, Visualization. Kelly Johnson-Arbor: Writing – review & editing, Writing – original draft, Conceptualization.

References (16)D.R. Hingwala et al.Susceptibility weighted imaging in the evaluation of movement disorders

Clin Radiol

(2013)

L. Leyssens et al.Cobalt toxicity in humans-a review of the potential sources and systemic health effects

Toxicology

(2017)

V. Sehgal et al.Clinical applications of neuroimaging with susceptibility-weighted imaging

J Magn Reson Imaging

(2005)

C. Liu et al.Susceptibility-weighted imaging and quantitative susceptibility mapping in the brain

J Magn Reson Imaging

(2015)