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Updated: Aug 1, 2025
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Noninvasive differentiation of porto-sinusoidal vascular disorder from cirrhosis: a systematic review
Suprabhat Giri1, Ankita Singh2, Akash Roy3
1Department of Gastroenterology, Nizam's Institute of Medical Sciences, 4th Floor, Specialty Block, Panjagutta, Hyderabad, Telangana, 500082, India.
Insights
Noninvasive imaging, including elastography and CT/MRI, can distinguish Porto-sinusoidal vascular disorder (PSVD) from early cirrhosis. These methods offer a less invasive alternative to liver biopsy for diagnosing PSVD.
Area of Science:
- Hepatology
- Radiology
- Diagnostic Imaging
Background:
- Porto-sinusoidal vascular disorder (PSVD) presents overlapping features with early cirrhosis, a common cause of portal hypertension.
- Distinguishing PSVD from cirrhosis traditionally requires invasive liver biopsy, carrying risks and complications.
- Accurate differentiation is crucial for appropriate patient management and treatment strategies.
Conclusions:
- Elastography and cross-sectional imaging demonstrate good accuracy in differentiating PSVD from early cirrhosis.
- These noninvasive methods provide a valuable alternative to liver biopsy.
- Further research is needed to explore the combined diagnostic utility of these modalities.
Background:
Porto-sinusoidal vascular disorder (PSVD) is one of the common causes of portal hypertension and has overlapping features with early cirrhosis. The differentiation of PSVD from cirrhosis requires a liver biopsy, which is invasive and has potential complications. This systematic review aimed at summarizing the current evidence on the performance of noninvasive modalities for differentiating PSVD from cirrhosis.
Methods:
A comprehensive search of electronic databases of MEDLINE, Embase, and Scopus was conducted from 2000 to October 2022 for the studies comparing the elastographic and radiological features of PSVD and cirrhosis, using liver biopsy as the gold standard.
Results:
A total of 12 studies were included in the systematic review. Transient elastography (TE) as a modality was studied in five studies, MR elastography (MRE) in two, contrast CT in two, Contrast CT and MRI in two, and ARFI in only one. Both TE and MRE showed a significantly lower liver stiffness measurement and a higher splenic stiffness measurement with a higher SSM/LSM ratio with PSVD, compared to cirrhosis. Among the radiological features, focal nodular hyperplasia-like lesions, portal vein abnormalities (intrahepatic and extrahepatic), and a larger spleen size favored a diagnosis of PSVD. In contrast, surface nodularity and atrophy of segment IV with a segment I hypertrophy favored a diagnosis of cirrhosis.
Conclusion:
Elastography and cross-sectional imaging can help differentiate PSVD from early cirrhosis with good accuracy. Further studies are required to assess the diagnostic role of a combination of both modalities.
