Weekly Case

Title : Case 844

Age / Sex : 20 / F

C.C amenorrhea

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)

Courtesy :  이영한 (Young Han Lee)  연세의대 세브란스병원 (Yonsei University Severance Hospital)


Serous atrophy of bone marrow (gelatinous transformation of bone marrow)


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.

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. 

Correct Answer
Total applicants 31 Correct answers 24
Name Institution
윤유성 경북대학교병원, 전문의
이규정 고려대학교 안암병원, 전문의
김정아 전공의
김재민 원주연세병원, 전문의
박상옥 플러스정형외과, 전문의
권기언 전문의
김신영 양산부산대학교병원, 전공의
임승현 강동경희대학교병원, 전공의
도윤아 전문의
김지환 전문의
박호영 전문의
강지희 전문의
홍상협 전문의
송윤아 전문의
김종혁 전문의
홍성호 서울대학교병원, 전공의
홍혁기 전공의
박혜주 순천향대학교 부천병원, 전공의
김승관 전문의
오지수 전문의
전예진 전문의
김경호 전문의, 전문의
김성진 전문의
이수민 전문의