{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T02:14:21Z","timestamp":1773195261086,"version":"3.50.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008092","name":"Jinhua Science and Technology Bureau","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008092","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Serous atrophy of the bone marrow (SABM) is primarily caused by the breakdown of bone marrow fat due to the depletion of body fat reserves. SABM is linked to poor nutritional status or cachexia in advanced cancer stages and exhibits distinct characteristics on magnetic resonance imaging (MRI). However, these adverse conditions create challenges for undergoing MRI, thereby delaying timely diagnosis. This case report details changes in body fat tissue observed through CT scans during the progression of two SABM cases. Two patients were elderly males, and both had undergone chemotherapy and immunotherapy following gastric cancer resection. The MRI scans of both patients revealed the characteristic \u201cflip-flop\u201d effect, in which T1WI appears to show fat suppression, while fat-suppressed T2WI appears to show fat without suppression. This finding differs from other bone marrow disorders and led to a diagnosis of SABM. Previous longitudinal CT analyses indicated that both subcutaneous and visceral fat tissues were not only reduced but had ultimately disappeared, resulting in a fluid-like density in the CT images of two cases. This finding indicates the depletion of body fat reserves. Furthermore, it suggests a significant deterioration in nutritional status and raises strong suspicion regarding the potential development of SABM.<\/jats:p>","DOI":"10.3389\/fonc.2026.1750230","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T05:31:57Z","timestamp":1773120717000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serous atrophy of bone marrow manifested as subcutaneous and visceral fat depletion on CT: two case reports"],"prefix":"10.3389","volume":"16","author":[{"given":"Zheng","family":"Han","sequence":"first","affiliation":[{"name":"Department of Radiology, Jinhua Municipal Central Hospital","place":["Jinhua, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiang-Feng","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinhua Municipal Central Hospital","place":["Jinhua, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinhua Municipal Central Hospital","place":["Jinhua, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"B1","article-title":"The gelatinous bone marrow (serous atrophy) in patients with acquired immunodeficiency syndrome","volume":"116","author":"Mehta","year":"1992","journal-title":"Evidence excess sulfated glycosaminoglyc Arch Pathol Lab Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1097\/00000478-200001000-00007","article-title":"Gelatinous transformation of the bone marrow: the spectrum of underlying diseases","volume":"24","author":"B\u00f6hm","year":"2000","journal-title":"Am J Surg Pathol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.193.3.7972838","article-title":"Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease","volume":"193","author":"Vande Berg","year":"1994","journal-title":"Radiology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-015-3692-5","article-title":"MRI findings of serous atrophy of bone marrow and associated complications","volume":"25","author":"Boutin","year":"2015","journal-title":"Eur Radiol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-025-04963-w","article-title":"Recognizing serous atrophy of bone marrow: a review of imaging findings","volume":"54","author":"Toma","year":"2025","journal-title":"Skeletal Radiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-014-3145-3","article-title":"MR Imaging in a case of severe anorexia nervosa: the \u2018flip-flop\u2019 effect","volume":"45","author":"DiVasta","year":"2015","journal-title":"Pediatr Radiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e243770","DOI":"10.1136\/bcr-2021-243770","article-title":"MRI findings seen in serous atrophy of bone marrow","volume":"14","author":"Kalamar","year":"2021","journal-title":"BMJ Case Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s13550-021-00834-2","article-title":"Imaging modalities for diagnosis and monitoring of cancer cachexia","volume":"11","author":"Han","year":"2021","journal-title":"EJNMMI Res"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.22.27749","article-title":"CT-derived body composition assessment as a prognostic tool in oncologic patients: from opportunistic research to artificial intelligence-based clinical implementation","volume":"219","author":"Bates","year":"2022","journal-title":"AJR Am J Roentgenol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S54","DOI":"10.1002\/jpen.2420","article-title":"Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient","author":"Prado","year":"2023","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00256-020-03465-1","article-title":"Glossary of terms for musculoskeletal radiology","volume":"49","author":"Palmer","year":"2020","journal-title":"Skeletal Radiol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-2532","article-title":"Increased bone marrow fat in anorexia nervosa","volume":"94","author":"Bredella","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-017-3856-3","article-title":"Bone marrow fat content in 70 adolescent girls with anorexia nervosa: Magnetic resonance imaging and magnetic resonance spectroscopy assessment","volume":"47","author":"Ecklund","year":"2017","journal-title":"Pediatr Radiol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-023-00734-5","article-title":"Cancer-associated cachexia - 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