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Non-invasive evaluation of portal hypertension using ultrasound elastography

  • Annalisa Berzigotti
    Correspondence
    Corresponding author. Address: Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, MEM F807, Murtenstrasse 35, CH - 3010 Berne, Switzerland. Tel.: +41 31 632 87 27; fax: +41 31 632 49 97.
    Affiliations
    Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland
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Published:February 13, 2017DOI:https://doi.org/10.1016/j.jhep.2017.02.003

      Summary

      Portal hypertension (PH) leads to serious complications, such as bleeding from gastroesophageal varices, ascites and portosystemic encephalopathy in patients with chronic liver disease (CLD). Gold standard methods for assessing PH and its complications include the measurement of hepatic venous pressure gradient and endoscopy; however, these are invasive, expensive and not available at all centres. Therefore, non-invasive alternatives have been the subject of extensive investigation over the last 20 years. The present review focuses on the role of ultrasound elastography - a novel group of non-invasive techniques used to measure stiffness in target organs. In the context of CLD these methods are used to identify the presence of PH, its severity, and the risk of PH-related complications. The rationale, accumulated evidence, advantages and limitations of liver and spleen stiffness measurements evaluated by different ultrasound elastography techniques in patients with advanced CLD is discussed. Recent data regarding the use of ultrasound elastography techniques in patients with non-cirrhotic forms of PH are also described.

      Keywords

      Linked Article

      • Prospective validation of transient elastography for staging liver fibrosis in patients undergoing hepatectomy and liver transplantation
        Journal of HepatologyVol. 68Issue 1
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          We read with great interest the recent review by Berzigotti in which she confirms the validity of liver stiffness measurement (LSM) by transient elastography (TE) to accurately diagnose compensated advanced chronic liver disease (cACLD) and predict clinically significant portal hypertension.1 Recently, the Baveno VI consensus and European Association for the Study of the Liver guidelines have proposed an LSM cut-off of 10 kPa for determining cACLD.2,3 LSM <10 kPa would exclude cACLD, and LSM >15 kPa would be highly indicative of cirrhosis; for results between these two points, additional work-up would be needed.
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