Noninvasive Assessment of Portal Hypertension in Chronic Liver Disease

Portal hypertension, a hallmark of advanced chronic liver disease, arises from increased resistance to portal blood flow and contributes to life-threatening complications such as variceal bleeding and ascites. Historically, the hepatic venous pressure gradient (HVPG) has served as the gold standard for quantifying portal pressure, yet its invasive nature limits widespread application. Over the past decade, noninvasive approaches have emerged to estimate portal pressure and stratify risk without the need for catheterisation. Among these, ultrasound-based elastography techniques—principally liver stiffness measurement (LSM) and spleen stiffness measurement (SSM)—have demonstrated strong correlations with HVPG and predictive value for clinically significant portal hypertension (CSPH). Composite algorithms incorporating simple laboratory parameters, imaging-derived stiffness values and endoscopic findings have further refined the selection of candidates for preventive therapy. Collectively, these advances have shifted clinical practice towards a multi-modality, risk-adapted framework that reduces reliance on invasive procedures while preserving diagnostic accuracy and guiding management in patients with chronic liver disease.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Noninvasive Assessment of Portal Hypertension in Chronic Liver Disease publication trend

The graph below shows the total number of articles in noninvasive assessment of portal hypertension in chronic liver disease across all publications each year (not limited to Nature Index journals).

Technical terms

Portal hypertension: Elevated pressure within the portal venous system, often defined by an HVPG ≥5 mmHg and clinically significant when ≥10 mmHg.

Hepatic venous pressure gradient (HVPG): The difference between wedged and free hepatic vein pressures; gold standard for measuring portal pressure.

Clinically significant portal hypertension (CSPH): A threshold of portal pressure (HVPG ≥10 mmHg) associated with the development of varices and clinical decompensation.

Liver stiffness measurement (LSM): Quantitative assessment of hepatic tissue elasticity via elastography, reflecting fibrosis and portal resistance.

Spleen stiffness measurement (SSM): Elastographic evaluation of spleen elasticity, serving as an indirect marker of portal hypertension.

Transient elastography: A noninvasive ultrasound-based technique that applies a shear wave to measure tissue stiffness in kilopascals.

Non-selective beta-blockers (NSBBs): Medications that reduce portal pressure by decreasing cardiac output and splanchnic blood flow, used to prevent variceal bleeding.

References

1. Exploring algorithms to select candidates for non-selective beta-blockers in cirrhosis: A post hoc analysis of the PREDESCI trial. Journal of Hepatology (2024).
2. Spleen stiffness measurement predicts decompensation and rules out high-risk oesophageal varices in primary biliary cholangitis. JHEP Reports (2023).
3. Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis. European Radiology (2020).