Belgian IMHA study questions routine imaging in dogs

A new retrospective study from Belgium adds to a long-running clinical question in canine immune-mediated haemolytic anaemia: how much routine diagnostic imaging really changes outcomes. In this cohort from the University of Liège, dogs with non-associative IMHA that underwent thoracic radiographs and abdominal ultrasound did not have better survival odds at 3, 6, or 12 months than dogs that had partial or no imaging, suggesting a blanket imaging approach may not be necessary in every case. (orbi.uliege.be)

The study was presented at ECVIM-CA Congress 2024 and appears to underpin the new Journal of Small Animal Practice item referenced in the source material. Investigators retrospectively reviewed dogs diagnosed with IMHA at a university teaching hospital between 2017 and 2023. Two blinded board-certified internal medicine specialists classified cases as associative or non-associative IMHA, with a third reviewer used if needed. That design is notable because the distinction between primary and secondary disease remains clinically important, especially when clinicians are deciding how aggressively to search for neoplasia, infection, inflammation, or other triggers. (orbi.uliege.be)

In the Belgian cohort, 122 dogs met inclusion criteria. Only 7 dogs, or 5.7%, were classified as associative IMHA, while 115, or 94.3%, were classified as non-associative IMHA. For dogs with non-associative disease and at least 3 months of follow-up, survival was 50.7% at 3 months, 43.3% at 6 months, and 30.5% at 12 months. When the authors compared dogs that received both ultrasound and radiographs with those that had partial or no imaging, diagnostic imaging did not significantly affect survival at any of those time points. The authors also noted that Shih Tzus were overrepresented, and suggested the low rate of associative IMHA may reflect regional differences. (orbi.uliege.be)

Those findings land in the context of existing guidance that already stops short of recommending identical imaging workups for every patient. The ACVIM consensus statement on IMHA diagnosis says imaging and other testing to screen for cancer are reasonable, but should be left to clinician discretion based on the likelihood of underlying disease in the individual patient. Prior published work on imaging in canine IMHA has also found that abnormalities are often present, but many overlap with incidental findings or changes seen in other diseases, which can limit specificity and downstream clinical value. (pmc.ncbi.nlm.nih.gov)

No outside expert commentary was readily available on this specific Belgian study, and the available public record is an ECVIM congress abstract rather than a full open-access paper. Still, the study’s message is consistent with a broader evidence trend: in IMHA, more testing does not automatically mean more actionable information. That is an inference based on the abstract’s survival analysis and prior literature on low-specificity imaging findings, rather than a direct claim from the authors beyond their reported outcomes. (orbi.uliege.be)

Why it matters: For general practitioners, internists, and emergency teams, this study may support more selective use of thoracic radiographs and abdominal ultrasound in dogs that otherwise fit a non-associative IMHA picture. That could matter for cost, patient stability, anesthesia or restraint decisions, and the timing of immunosuppressive treatment and transfusion support. It does not argue against imaging when signalment, physical exam findings, lab work, or history raise suspicion for neoplasia, infection, or another trigger. Instead, it reinforces a case-based approach, which may be especially useful when discussing diagnostic priorities and financial tradeoffs with pet parents. (orbi.uliege.be)

What to watch: The next key step is the full peer-reviewed publication, which could clarify inclusion criteria, imaging findings, how often imaging changed management, and whether any clinical subgroups derived more benefit. If those details emerge, they could help refine when imaging should be routine, deferred, or targeted in canine IMHA workups. (orbi.uliege.be)