Hematologic malignancies often present with nonspecific symptoms, and the increasing use of MRI for various indications has led to the incidental detection of bone marrow signal anomalies, which can prompt further diagnostic evaluation. When such anomalies are identified, additional investigations, including bone marrow examination, may be necessary to exclude a neoplastic process. However, some signal anomalies are physiological, potentially leading to unnecessary further assessments. The incidence of these anomalies is currently unknown, no guidelines exist for their management and they are an increasingly source of costly investigations. This article illustrates the difficulties of interpreting these MRI anomalies through clinical cases, and proposes a multidisciplinary diagnostic approach.