Flip-flop effect
Updates to Article Attributes
The so-called flip-flop effect refers to a confusing MRI appearance of the skeletal system and subcutaneous tissues. It is seen in a variety of severe fat depletion conditions responsible for diffuse bone marrow serous atrophy and modification or loss of the subcutaneous fat.
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. Intermediate to 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).
These confusing MRI findings can be confirmed by spectroscopic analysis or Dixon technique confirming fat depletion and water predominance to avoid misinterpreting these images as technical problem and unnecessarily repeating the exam2, 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 kidney disease
- tuberculosis
- thyroid disease
-<p>The so-called <strong>flip-flop effect </strong>refers to a confusing MRI appearance of the skeletal system and subcutaneous tissues. It is seen in a variety of severe fat depletion conditions responsible for diffuse bone marrow serous atrophy and modification or loss of the subcutaneous fat.</p><h4>Pathology</h4><p>Diffuse serous atrophy of the bone marrow occurs in a variety of medical conditions<sup>1 </sup>(mainly anorexia nervosa and severe cachexia), where, due to hormonal and cellular depletion/imbalance<sup>2</sup>, marrow fat will be replaced by watery substance and extracellular fluid<sup>3</sup>.</p><h4>Radiographic features</h4><p>This phenomenon will increase <a href="/articles/relaxometry">T1</a> and <a href="/articles/relaxometry">T2</a> relaxation times<sup>1</sup> leading to confusing MRI findings. Intermediate to 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 sequences<sup>4 </sup>(T2 Fat Sat and <a href="/articles/short-tau-inversion-recovery">STIR</a>).</p><p>These confusing MRI findings can be confirmed by <a href="/articles/mr-spectroscopy-1">spectroscopic</a> analysis or <a href="/articles/dixon-method">Dixon</a> technique confirming fat depletion and water predominance to avoid misinterpreting these images as technical problem and unnecessarily repeating the exam<sup>2, 4</sup>. </p><h4>Diagnostic considerations</h4><p>Diffuse bone marrow serous atrophy can occur in:</p><ul>- +<p>The so-called <strong>flip-flop effect </strong>refers to a confusing MRI appearance of the skeletal system and subcutaneous tissues. It is seen in a variety of severe fat depletion conditions responsible for diffuse <a title="Gelatinous marrow transformation" href="/articles/gelatinous-marrow-transformation">bone marrow serous atrophy</a> and modification or loss of the subcutaneous fat.</p><h4>Pathology</h4><p>Diffuse <a title="Gelatinous marrow transformation" href="/articles/gelatinous-marrow-transformation">serous atrophy of the bone marrow</a> occurs in a variety of medical conditions<sup>1 </sup>(mainly anorexia nervosa and severe cachexia), where, due to hormonal and cellular depletion/imbalance<sup>2</sup>, marrow fat will be replaced by watery substance and extracellular fluid<sup>3</sup>.</p><h4>Radiographic features</h4><p>This phenomenon will increase <a href="/articles/relaxometry">T1</a> and <a href="/articles/relaxometry">T2</a> relaxation times<sup>1</sup> leading to confusing MRI findings. Intermediate to 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 sequences<sup>4 </sup>(T2 Fat Sat and <a href="/articles/short-tau-inversion-recovery">STIR</a>).</p><p>These confusing MRI findings can be confirmed by <a href="/articles/mr-spectroscopy-1">spectroscopic</a> analysis or <a href="/articles/dixon-method">Dixon</a> technique confirming fat depletion and water predominance to avoid misinterpreting these images as technical problem and unnecessarily repeating the exam<sup>2, 4</sup>. </p><h4>Diagnostic considerations</h4><p>Diffuse <a title="Gelatinous marrow transformation" href="/articles/gelatinous-marrow-transformation">bone marrow serous atrophy</a> can occur in:</p><ul>
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Image 1 MRI (T1) ( create )
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