Ultrasound-Guided Fine-Needle vs. Transjugular Portal Pressure Measurements in Non-Viral, Non-Alcoholic Cirrhosis

Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension in patients with viral- and alcohol-related cirrhosis, but its accuracy is limited in other aetiologies. This study aimed to evaluate the correlation of portal venous pressure measurements in patients with non-alcoholic, non-viral-related decompensated cirrhosis, using fine-needle puncture (FN-PVP), direct portal vein catheterisation (D-PVP) and wedged hepatic vein balloon occlusion (WHVP).

This study retrospectively included patients from the author's centre who simultaneously underwent FN-PVP, HVPG and transjugular intrahepatic portosystemic shunt (TIPS) placement for variceal bleeding or refractory ascites. The Spearman correlation coefficient (r), linear regression coefficient (R²), intraclass correlation coefficient (ICC) and the Bland-Altman method were used to assess the correlation and consistency between the pressure measurements obtained by the different methods.

Seventy-one patients were included, all undergoing FN-PVP measurements without procedure-related complications. The correlation and consistency between WHVP and D-PVP were moderate (r = 0.487, R² = 0.25), while FN-PVP demonstrated excellent correlation and consistency with D-PVP (r = 0.945, R² = 0.914). Similar patterns were observed when comparing HVPG and direct portal pressure gradient (D-PPG), fine-needle portal pressure gradient (FN-PPG) and D-PPG (r: 0.558 vs. 0.918; R²: 0.302 vs. 0.87). In patients without intrahepatic venovenous shunts (IHVS), the correlation and consistency between WHVP and D-PVP showed slight improvement (r = 0.609, ICCa = 0.523, ICCc = 0.620). Using D-PPG as the benchmark, FN-PPG demonstrated excellent classification accuracy, significantly outperforming HVPG.

In patients with non-alcoholic, non-viral-related PHT, HVPG may underestimate the true PPG, regardless of the presence of IHVS. In contrast, FN-PVP can safely and accurately reflect portal pressure and serves as an effective alternative for direct portal pressure measurement.