Flip-flop effect

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The so-called flip-flop effect refers to a confusing MRI appearance of the musculoskeletal system in a variety of severely depleted fat stores conditions responsible of diffuse bone marrow serous atrophy.

Pathology

Diffuse serous atrophy of the bone marrow occurs in a variety of medical conditions¹(mainly anorexia nervosa and severe cachexia), where, due to hormonal and cellular depletion/imbalance², marrow fat will be replaced by watery substance and extracellular fluid³.

Radiographic features

This phenomenon will increase T1 and T2 relaxation times¹ leading to confusing MRI findings. Low bone marrow and soft tissue signal will be seen on T1 weighted images while high signal intensity of these compartments will be found on fat-suppressed fluid sensitive sequences⁴(T2 Fat Sat and STIR).

This confusing MRI finding can be confirmed by spectroscopic analysis or Dixon technique confirming the fat depletion and the water predominance to avoid misinterpreting these images as technical problem and unnecessary repeating the exam^{2, 4}.

Diagnostic considerations

Diffuse bone marrow serous atrophy can occur in:

severe anorexia nervosa
cancer-related cachexia
neoplastic marrow disease under chemotherapy
human immunodeficiency virus infection
chronic ~~renal insufficiency~~kidney disease
tuberculosis
thyroid disease

-The so-called flip-flop effect refers to a confusing MRI appearance of the musculoskeletal system in a variety of severely depleted fat stores conditions responsible of diffuse bone marrow serous atrophy.Diffuse serous atrophy of the bone marrow occurs in a variety of medical conditions1 (mainly anorexia nervosa and severe cachexia), where, due to hormonal and cellular depletion/imbalance2, marrow fat will be replaced by watery substance and extracellular fluid3.This phenomenon will increase T1 and T2 relaxation times1 leading to confusing MRI findings. Low bone marrow and soft tissue signal will be seen on T1 weighted images while high signal intensity of these compartments will be found on fat-suppressed fluid sensitive sequences4 (T2 Fat Sat and STIR).This confusing MRI finding can be confirmed by spectroscopic analysis or Dixon technique confirming the fat depletion and the water predominance to avoid misinterpreting these images as technical problem and unnecessary repeating the exam2, 4. Diffuse bone marrow serous atrophy can occur in:<ul>
+The so-called flip-flop effect refers to a confusing MRI appearance of the musculoskeletal system in a variety of severely depleted fat stores conditions responsible of diffuse bone marrow serous atrophy.<h4>Pathology</h4>Diffuse serous atrophy of the bone marrow occurs in a variety of medical conditions1 (mainly anorexia nervosa and severe cachexia), where, due to hormonal and cellular depletion/imbalance2, marrow fat will be replaced by watery substance and extracellular fluid3.<h4>Radiographic features</h4>This phenomenon will increase <a href="/articles/relaxometry">T1</a> and <a title="T2 relaxometry" href="/articles/relaxometry">T2</a> relaxation times1 leading to confusing MRI findings. Low bone marrow and soft tissue signal will be seen on <a href="/articles/t1-weighted-image">T1 weighted </a>images while high signal intensity of these compartments will be found on fat-suppressed fluid sensitive sequences4 (T2 Fat Sat and <a href="/articles/short-tau-inversion-recovery">STIR</a>).This confusing MRI finding can be confirmed by <a href="/articles/mr-spectroscopy-1">spectroscopic</a> analysis or <a href="/articles/dixon-method">Dixon</a> technique confirming the fat depletion and the water predominance to avoid misinterpreting these images as technical problem and unnecessary repeating the exam2, 4. <h4>Diagnostic considerations</h4>Diffuse bone marrow serous atrophy can occur in:<ul>
~~-<li>chronic renal insufficiency</li>~~
+<li><a href="/articles/chronic-kidney-disease">chronic kidney disease</a></li>