MRI findings seen in serous atrophy of bone marrow

An 85-year-old man was referred for an MRI scan of the pelvis for further evaluation of a suspected left neck of femur fracture, which was regarded as equivocal on plain radiograph and CT. The initial MRI demonstrated unusual appearances of the visualised bone marrow and subcutaneous adipose tissue and was initially misinterpreted as a technical malfunction of the scanner. However, a repeat study on a different scanner the following day once again demonstrated the same appearances. The appearances were consistent with serous atrophy of bone marrow, a non-neoplastic disorder of the bone marrow, which is most commonly seen in severe anorexia nervosa or cachexia. These unusual, but distinct, bone marrow and subcutaneous adipose tissue appearances, which are specific to MRI, have been colloquially termed as the 'flip-flop' effect.