A better understanding and characterization of the disease process in myelofibrosis could be achieved by analyzing imaging results, according to a study recently published in Tomography.

“As a single technique, we feel that T1-weighted MRI best reflected the response to ruxolitinib therapy,” the authors wrote.

Read more about myelofibrosis diagnosis

This prospective observational study included 4 patients previously diagnosed with myelofibrosis. Almost all (n=3) were females. Participants were 45 to 75 years of age. All participants underwent laboratory testing, bone marrow biopsies, and spinal imaging.

The researchers later compared their Dixon, dynamic contrast-enhanced T1-weighted magnetic resonance imaging (DCE-MRI) result with a 66-year-old male with a previous history of back surgery due to herniated disks as a control. The controls for the [15O]water positron emission tomography (PET) were 6 males and 2 females of 42 to 87 years of age with a history of coronary artery disease.

Compared to such controls, all patients with myelofibrosis exhibited decreased marrow fat content, increased blood flow, and high osteoblastic activity in the images done as baseline reports. Unfortunately, 1 patient died prior to the follow-up. In the remaining 3 participants, the bone marrow fat content kept increasing, and [18F]NaF uptake in the vertebras remained stable during ruxolitinib treatment. Only 1 patient showcased normalization of blood flow; interestingly, this patient also experienced the fastest clinical response to treatment.

The histopathological evaluation did not yield similar information to imaging techniques. Furthermore, the authors encountered many obstacles regarding bone marrow biopsies. For example, many samples could not be analyzed, highlighting the challenges of obtaining such samples.

“Moreover, we suspected one case of BM sampling error—supported by the presence of patchy disease on T1-weighted images (Pt3 T18)—and the comparison of pelvic BM biopsies to vertebral imaging results was suboptimal,” the authors noted.

These results suggest that imaging could become an important tool when evaluating bone marrow parameters in patients with myelofibrosis undergoing treatment, especially since the current gold standard (bone marrow biopsy) faces many difficulties.


Slot S, Lavini C, Zwezerijnen G. Characterizing the bone marrow environment in advanced-stage myelofibrosis during ruxolitinib treatment using PET/CT and MRI: a pilot study. Tomography. Published online February 21, 2023. doi:10.3390/tomography9020038