Portal hypertension (PH), a serious complication of liver cirrhosis, is defined as a pressure gradient > 5 mmHg between the portal vein and the inferior vena cava. When hepatic venous pressure gradient (HVPG) exceeds 10 mmHg, the condition becomes clinically significant and complications increase significantly, making early detection critical to guide treatment.
A recent revision was made available online on March 1, 2025, and published on March 17, 2025, in Portal Hypertension & Cirrhosis The journal explores whether advances in ultrasound technology can provide a reliable, non-invasive method for assessing PH.
PH develops when resistance to blood flow through the liver increases, most often due to cirrhosis, increasing the pressure on the portal vein system. The review describes how different ultrasound techniques can detect these changes.
Traditional B-type ultrasound can reveal structural features of cirrhosis, such as nodular liver surface, altered liver shape, and dilated vessels, as well as indirect signs of PH, including splenomegaly and ascites.
Doppler ultrasound allows clinicians to assess the direction and speed of blood flow in the portal vein and surrounding vessels. In cirrhosis, portal vein flow often slows and in severe cases can reverse direction, a pattern known as hepatofugal flow that indicates advanced PH.
Because no single measurement fully captures disease severity, clinicians evaluate several ultrasound parameters together, an approach known as multiparametric ultrasound.
Elastography, another method discussed in the review, measures liver stiffness as an indicator of fibrosis progression and PH severity.
Researchers also highlight contrast-enhanced ultrasound, which characterizes hepatic blood flow by monitoring a contrast agent injected through the hepatic vessels, the clinicians. However, individual variations in flow patterns and the development of collateral vessels can complicate interpretation.
While ultrasound cannot yet completely replace invasive pressure measurements, multiparametric ultrasound offers a practical, noninvasive alternative that can help clinicians better understand the complex changes occurring in liver disease and support both patient monitoring and clinical decision-making.
Notably, the study also offers ultrasound recommendations for specific scenarios, adding practical value for clinicians and researchers.
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