Splenic shear wave elastography beyond portal hypertension: a narrative review of non-portal applications

Shear wave elastography is a non-invasive ultrasound technique that quantifies tissue stiffness with high reproducibility. While its role in assessing portal hypertension is well established, the spleen has recently gained attention as a potential biomarker in non-portal conditions. As a vascular and immune organ, the spleen undergoes structural and functional changes in various systemic diseases, making splenic shear wave elastography a promising diagnostic and prognostic tool. This review summarizes current evidence regarding splenic shear wave elastography in healthy individuals and in diseases beyond portal hypertension. In hematologic disorders, particularly myeloproliferative neoplasms, splenic stiffness correlates with bone marrow fibrosis, extramedullary hematopoiesis, and thrombotic complications. In cardiovascular conditions, splenic congestion reflects systemic venous pressure and has been studied in acute and chronic heart failure, as well as in congenital circulatory alterations such as Fontan physiology. Research in inherited storage diseases, transfusion-dependent anemias, and autoinflammatory syndromes suggests a role for shear wave elastography in detecting parenchymal infiltration and monitoring disease progression. Infectious diseases including brucellosis, schistosomiasis, and HIV-related vasculopathy, further highlight its sensitivity to microvascular and inflammatory changes. Pediatric studies have expanded normative reference ranges and explored applications in systemic infections and splenomegaly. Despite encouraging findings, methodological heterogeneity, variability among ultrasound platforms, and physiological confounders limit comparability across studies. Current evidence remains predominantly based on small, single-center cohorts, and disease-specific cutoff values have yet to be established. In conclusion, splenic shear wave elastography shows potential for broad clinical applicability, but standardization of protocols, multicenter validation, and integration into multiparametric ultrasound frameworks are needed before implementation in routine practice.