The Teaching Point

`Flip-Flop` is a unique imaging manifestation in MRI resulting from the underlying pathological process of serous atrophy of bone marrow. It is seen generally in patients with poor nutritional status and low stores of body fat. The MRI findings in serous atrophy of bone marrow are uncommon, and to an unsuspecting radiologist and clinician, it might masquerade as generalized marrow infiltrative disorder thus potentially misdirecting the patient management. History of chronic illness or eating disorder along with significant paucity of adjacent subcutaneous fat on imaging should prompt the radiologist to this phenomenon. The radiologist should also carefully screen for insufficiency fractures which are difficult to identify but are not uncommon in these patients.






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From the manuscript

"Flip-Flop Phenomenon" - Magnetic Resonance Imaging Pitfall: A Case Report

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Abstract
A 66-year-old cachectic female with underlying anorexia nervosa and lower limb weakness was referred for a spinal Magnetic Resonance Imaging. Imaging appearances were initially thought to represent underlying systemic pathology involving bone marrow or inadvertent wrong selection of imaging sequences. It was, however, established that unique imaging appearances are secondary to `Flip-Flop` phenomenon owing to underlying nutritional status of the patient. `Flip-Flop` phenomenon on the Magnetic Resonance Imaging is result of an underlying pathological process of serous atrophy of bone marrow. Appreciation and recognition of this phenomenon will help in the correct interpretation of the images and leads a clinician toward appropriate management.






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