Photo Credit: Sergey Lobodenko

Spleen and liver elastography can help diagnose myeloproliferative neoplasms and differentiate myelofibrosis from other myeloproliferative neoplasms.

Liver and spleen shear-wave elastography helped distinguish patients with myelofibrosis from healthy controls and those with essential thrombocytopenia, according to findings published in the Journal of Ultrasound. This suggests that the technique may help diagnose myeloproliferative neoplasms.

Researchers added that liver stiffness and spleen stiffness appeared to be linked with bone marrow fibrosis.

“Vibration-controlled transient elastography (VCTE) has proven to be a valuable tool in providing prognostic and staging information in patients with liver disease, greatly reducing the need for liver biopsy,” Vito Sansone, MD, PhD-student, and colleagues wrote. “Spleen stiffness, similarly, has proven useful as a surrogate marker of portal hypertension. To date, however, the role of any of these techniques in the work-up of MPNs has not been established. …This study aims to investigate if values of liver and spleen stiffness measured with shear-wave elastography could help to differentiate MPNs from healthy controls and if there are significant differences in values of liver stiffness and spleen stiffness.”

Study Parameters

The researchers performed a single-center study of 143 patients with MPNs and 75 healthy control participants. Patients had previously been enrolled in the RUX-MF and PV-NET studies. To be included, patients needed to be 18 or older, with myelofibrosis, essential thrombocytopenia, or polycythemia vera. Patients were excluded from the study if they had any hepatic disease, such as cirrhosis or hepatitis. All patients underwent shear wave point elastography and bidimensional elastography. Sansone and colleagues also evaluated the correlation between elastography and bone marrow fibrosis, history of splanchnic thrombosis, and other clinical variables.

Sixty-four patients (29.4%) had myelofibrosis, 15.1% had polycythemia vera (n=33), and 21.1% had essential thrombocytopenia (n=46). There were 75 (34.4%) healthy volunteers.

Patients with myelofibrosis were aged a mean of 71.9 years, compared with 62.4 years in the polycythemia vera population and 64.4 years in the essential thrombocytopenia population.

Elastography Score and MPNs

The researchers reported that patients with myelofibrosis had greater spleen stiffness than the control participants (40.9 versus 26.3 kPa for shear wave point, P<0.001; bidimensional,34.9 versus 20.1 kPa, P<0.001). These patients reportedly had greater liver stiffness than controls (shear-wave point, 7.72 versus 5.52 kPa, P<0.001; bidimensional, 6.96 versus 5.01 kPa, P<0.001).

Patients with low-grade bone-marrow fibrosis (grade 0-1, n=81, 60.4%) had a higher median liver stiffness (shear wave point, 5.2 versus 6.65 kPa; bidimensional, 5.1 versus 6.05 kPa) and a higher median spleen stiffness (shear wave point, 27.2 versus 37.9 kPa; bidimensional, 21.7 vs 30.75 kPa) compared with those who had high-grade bone-marrow fibrosis, Sansone and colleagues wrote (grade 2–3, n=42, 39.6%).

The researchers wrote that the study’s biggest limitation was that it did not include a follow-up period. Another limitation was the relatively small sample size; for this reason, Sansone and colleagues noted that studies with larger populations are necessary.

“We successfully showed how liver and spleen shear-wave elastography were able to correctly discriminate MF from other MPNs and healthy controls,” the researchers concluded. “Moreover, we confirmed a strong association of spleen stiffness with the grade of bone marrow fibrosis, strengthening the role of elastography as a viable non-invasive surrogate parameter.”

 Key Takeaways

• Vibration-controlled transient elastography has become valuable in providing prognostic and staging information.
• Dr. Sansone and colleagues found that patients with myelofibrosis had greater spleen and liver stiffness than the control participants.
• Both spleen and liver stiffness had an impact on bone marrow fibrosis
• The findings indicate that liver and spleen shear-wave elastography can discriminate myelofibrosis from other myeloproliferative neoplasms.