The future of splenic elastography: Is it a valuable tool for personalized treatment?

Portal hypertension is the main determinant of prognosis in cirrhosis of the liver. The gold standard for its evaluation is hepatic venous pressure gradient measurement. Because it is an invasive test performed only at highly specialized centers, noninvasive tools for the detection of portal hypertension have been developed. One of the most relevant is vibration-controlled transient elastography (FibroScan®; Echosens, Paris, France). Liver stiffness measurement is the most widely utilized and validated noninvasive tool, although more recent studies suggest spleen stiffness measurement correlates better with the hepatic venous pressure gradient. In the present narrative review, a comprehensive search of the literature was carried out on the PubMed/MEDLINE, Embase, and Cochrane CENTRAL databases, complemented by manual reference screening, to critically analyze the available evidence on splenic elastography in the noninvasive evaluation of portal hypertension. The following topics are addressed: the clinical impact of portal hypertension evaluation, the role of liver elastography as a noninvasive strategy, and the different applications of splenic elastography in the evaluation of portal pressure, including the diagnosis of clinically significant portal hypertension and severe portal hypertension, the prediction of esophageal varices and high-risk varices, clinical decompensation and recompensation risk assessment, and the usefulness of spleen stiffness measurement in monitoring the response to beta blocker therapy.