Non-invasive diagnosis of portal hypertension in cirrhosis using ultrasound based elastography.

Abstract

Liver stiffness measurement (LSM) by ultrasound-based elastography may be used to non-invasively discriminate betweenthe stages of liver fibrosis, rule out cirrhosis and follow its evolution, including the prediction of the presence ofoesophageal varices. The same is possible in order to diagnose clinically significant portal hypertension, referring primarilyto transient elastography and LSM values ≥20-25 kPa. The same approach may be used to reliably rule out the presence ofoesophageal varices (LSM <20 kPa + platelets >150x109/L). These recommendations refer primarily to patients with viral aetiologyof chronic liver disease (hepatitis C), while additional studies are required for other aetiologies. While spleen stiffnessmeasurement (SSM) also poses a logical choice in this indication, controversial results have nevertheless been published on this issue. It should be emphasized, however, that more recent data indicate that this parameter should be included in the diagnosticalgorithm for portal hypertension, if not as the sole then as a part of a sequential algorithm, combined with LSM. Untilnow, transient elastography has been most extensively studied and founded on scientific evidence, although the results of otherultrasound-based elastography techniques demonstrate the same trend for the non-invasive assessment of portal hypertension.