Can Non-Invasive Methods Be Clinically Useful for Diagnosis and Severity of Portal Hypertension?

Context: Current gold standard methods of diagnosing portal hypertension (endoscopy and hepatic vein pressure gradient) are not only invasive but also very expensive. Consequently, new non-invasive methods have been studied over the years to assess their Applicability in replacing current invasive procedures. This review explores the current use of abdominal ultrasonography, Doppler ultrasonography, contrast-enhanced ultrasonography, various elastography techniques, computed tomography, and magnetic resonance imaging in evaluating portal hypertension while exploring their advantages and disadvantages. Evidence Acquisition: We gathered data from international papers published in Pubmed/Medline, Cochrane Library, Google Scholar, Web of Science, Wiley Online Library, and Research Gate databases until October 2019. Papers analyzing the associations between non-invasive tests and either portal hypertension or its complications were included in the study. Results: Liver stiffness (LS) and spleen stiffness (SS), regardless of the used elastography method, have shown promising results, with liver stiffness already included in current guidelines to avoid screening endoscopy. Overall, the results suggest that SS is superior to LS for screening for portal hypertension and the presence of EV, but there is a need for additional studies to certify the data and further evaluate which would provide the most accurate assessment and if other parameters need to be included to better diagnose portal hypertension. Conclusions: Liver stiffness and spleen stiffness are the best currently available methods of detecting portal hypertension but require further research. They may reduce the number of hepatic vein pressure gradient measurements and endoscopies needed for the diagnosis and follow-up of patients with portal hypertension in the future.