THE ROLE OF ELASTOGRAPHY IN CLINICALLY SIGNIFICANT PORTAL HYPERTENSION

Area of Science:

• Hepatology
• Gastroenterology
• Diagnostic Imaging

Background:

• Clinically significant portal hypertension (CSPH) is a major complication in cirrhotic patients, increasing the risk of gastroesophageal varices (GEV) and bleeding.
• Endoscopic screening for GEV is invasive and carries risks, highlighting the need for non-invasive diagnostic alternatives.
• Compensated advanced chronic liver disease management aims to prevent CSPH development and its complications.

Approach:

• This narrative review discusses the role of elastographic methods in evaluating CSPH in cirrhotic patients.
• It proposes an algorithm for the non-invasive assessment of CSPH, focusing on liver and spleen stiffness measurements.
• The review highlights Vibration-Controlled Transient Elastography (VCTE), Shear Wave Elastography (SWE), and Magnetic Resonance Elastography (MRE) as key techniques.

Key Points:

• The Baveno VII consensus established the "rule of 5" for VCTE: liver stiffness measurement (LSM) ≤15 kPa with platelets >150,000/mm³ excludes CSPH, while LSM ≥25 kPa is highly suggestive of CSPH.
• The "rule of 4" for SWE suggests CSPH in patients with LSM ≥17 kPa.
• Spleen stiffness measurement (SSM) is emerging as a more specific predictor of CSPH.

Conclusions:

• Elastography is a valuable, non-invasive tool for evaluating CSPH in advanced chronic liver disease.
• These methods can help clinicians make informed decisions, potentially avoiding endoscopy and enabling timely prophylactic measures.
• The proposed algorithm utilizing elastography can guide patient management and improve outcomes in cirrhosis.