Is the hot cross bun sign on radiological imaging always significant or could it be a benign occurrence?

Hot buns: Usually refers to sign on an MRI is related to variety of neuro degenerative diseases not usually a begin appearance unless there was a problem with the film

If you are: referring to Brain MRI, the "hot cross buns" sign in the pons is the result of selective neuronal degeneration/loss in that area, so it is never normal. It is associated with a variety of neurodegenerative disorders, particularly multisystem atrophy.

The hot cross bun sign is an abnormality found on MRI of the Brain. There is loss of certain myelinated fibers in the pons (the brainstem) with preservation of other areas that gives this appearance. It is often associated with multisystem atrophy, however other disorders including the spinocerebellar ataxias should be excluded. Movement Disorder and Neurology specialties often interpret this