Abdominal ultrasonography in myelofibrosis

Area of Science:

• Radiology
• Oncology
• Hematology

Background:

• Myelofibrosis is a bone marrow disorder characterized by fibrosis and extramedullary hematopoiesis.
• Abdominal ultrasonography (US) is a non-invasive imaging modality used to assess organ involvement in myelofibrosis.

Purpose of the Study:

• To review abdominal US findings in patients with myelofibrosis.
• To evaluate the utility of US in identifying splenomegaly, hepatomegaly, and focal lesions.
• To determine if US can differentiate between extramedullary hematopoiesis and malignancy.

Main Methods:

• Retrospective review of abdominal US findings in 40 myelofibrosis patients.
• Analysis of spleen and liver characteristics, including size, echogenicity, and presence of focal lesions.
• Correlation of US findings with clinical diagnosis and biopsy results where available.

Main Results:

• Splenomegaly was present in 80% at initial diagnosis and 97% at later stages. Hepatomegaly was found in 25% at initial diagnosis and 39% at later stages.
• Focal splenic lesions were observed in 5 patients (metastases in 1, extramedullary hematopoiesis in 1). Focal hepatic lesions were seen in 7 patients (metastases in 3, extramedullary hematopoiesis in 2).
• Ultrasonography could not reliably differentiate between extramedullary hematopoiesis and malignancy.

Conclusions:

• Abdominal US is sensitive in detecting splenomegaly and hepatomegaly in myelofibrosis but has limitations in characterizing focal lesions.
• Distinguishing extramedullary hematopoiesis from malignancy using US alone is challenging.
• Fine-needle biopsy is recommended for definitive diagnosis of focal splenic and hepatic lesions in myelofibrosis.