Non-invasive tests that combine liver and spleen stiffness measurements with routine laboratory and imaging findings may help physicians identify portal hypertension and determine which patients need further testing, according to a review published in Portal Hypertension & Cirrhosis.
Portal hypertension occurs when pressure increases in the portal venous system and is a major complication of chronic liver disease. It can lead to variceal bleeding, ascites, and hepatic encephalopathy. Clinically significant portal hypertension (CSPH) is defined as a hepatic venous pressure gradient (HVPG) of at least 10 mmHg and is used to assess the risk of complications and guide management.
HVPG measurement remains the reference standard for diagnosing and grading portal hypertension. However, it requires catheterization of a hepatic vein as well as specialized equipment and expertise, limiting its suitability for routine screening and repeated monitoring.
Researchers at Huazhong University of Science and Technology reviewed evidence for alternatives including elastography, blood-based biomarkers, computed tomography, magnetic resonance imaging, and artificial intelligence (AI)-based models.
Among the most established approaches is transient elastography, which measures liver stiffness. Current Baveno VII criteria use liver stiffness together with platelet count to estimate the likelihood of CSPH. A liver stiffness measurement of 15 kPa or less with a platelet count of at least 150 × 10^9/L can rule out CSPH, whereas liver stiffness of at least 25 kPa can rule it in.
These criteria do not classify every patient, however. The review reported that approximately 40 to 60 percent may fall into an indeterminate range. Adding spleen stiffness measurement could reduce this diagnostic gray zone to approximately 7 to 15 percent in reported studies, potentially helping physicians decide who requires endoscopy or invasive pressure measurement.
Routine laboratory testing may also contribute to assessment. Platelet count, albumin, bilirubin, and markers associated with inflammation, fibrosis, and endothelial function have been evaluated alone or as part of composite models. Such approaches may provide additional options in settings where elastography is unavailable.
The researchers also reviewed AI models designed to combine imaging, laboratory, and clinical data. Some reported high diagnostic accuracy, including imaging-based models for identifying CSPH. However, the researchers emphasized that many require larger, multicenter studies, standardized protocols, and external validation before widespread clinical implementation.
Overall, the review outlined a stepwise approach in which readily available non-invasive tests are used for initial risk assessment, followed by additional testing for patients with uncertain results. HVPG or other direct pressure measurements would remain important when a definitive measurement is needed.
Newsletters
Receive the latest pathologist news, personalities, education, and career development – weekly to your inbox.
