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Age / Sex : 20 / F
C.C amenorrhea
What is your diagnosis?
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Courtesy : 이영한 (Young Han Lee) 연세의대 세브란스병원 (Yonsei University Severance Hospital)
Diagnosis: Serous atrophy of bone marrow (gelatinous transformation of bone marrow)
Discussion
Pathology
Diffuse serous atrophy of the bone marrow occurs in a variety of medical conditions, where due to hormonal and cellular depletion/imbalance, marrow fat is replaced by watery substance and extracellular fluid.
It is typically seen in cachexia, anorexia nervosa, or other eating disorders. Other conditions include: AIDS, alcohol excess. acute febrile illness, malignancies, chronic renal failure, congestive heart failure, myelodysplastic syndrome
Radiographic features
This phenomenon will increase T1 and T2 relaxation times leading to confusing MRI findings. Intermediate to low bone marrow and soft tissue signal will be seen on T1 weighted images while corresponding high signal intensity of these compartments will be found on fat-suppressed fluid sensitive sequences 4 (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 a technical problem, with ensuing unnecessary repetition on the MR study.
References
1. Vande Berg B, Malghem J, Devuyst O, Maldague B, Lambert M. Anorexia Nervosa: Correlation Between MR Appearance of Bone Marrow and Severity of Disease. Radiology. 1994;193(3):859-64.
2. DiVasta A, Mulkern R, Gordon C, Ecklund K. MR Imaging in a Case of Severe Anorexia Nervosa: The 'Flip-Flop' Effect. Pediatr Radiol. 2015;45(4):617-20.
3. Ecklund K, Vajapeyam S, Feldman H et al. Bone Marrow Changes in Adolescent Girls with Anorexia Nervosa. J Bone Miner Res. 2010;25(2):298-304.
4. Boutin R, White L, Laor T et al. MRI Findings of Serous Atrophy of Bone Marrow and Associated Complications. Eur Radiol. 2015;25(9):2771-8.
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