a UCL Institute for Liver and Digestive Health , Royal Free Hospital and UCL , London , UK.
b Liver Unit, Department of Internal Medicine , Valld'Hebron University Hospital, VHIR, Universitat Autònoma de Barcelona, CIBERehd , Barcelona , Spain.
Expert Rev Gastroenterol Hepatol. 2018 Feb;12(2):155-164. doi: 10.1080/17474124.2017.1374852. Epub 2017 Sep 12.
The gold standard to assess the presence and severity of portal hypertension remains the hepatic vein pressure gradient, however the recent development of non-invasive assessment using elastography techniques offers valuable alternatives. In this review, we discuss the diagnostic accuracy and utility of such techniques in patients with portal hypertension due to cirrhosis. Areas covered: A literature search focused on liver and spleen stiffness measurement with different elastographic techniques for the assessment of the presence and severity of portal hypertension and oesophageal varices in people with chronic liver disease. The combination of elastography with parameters such as platelet count and spleen size is also discussed. Expert commentary: Non-invasive assessment of liver fibrosis and portal hypertension is a validated tool for the diagnosis and follow-up of patients. Baveno VI recommended the combination of transient elastography and platelet count for ruling out varices needing treatment in patients with compensated advanced chronic liver disease. Assessment of aetiology specific cut-offs for ruling in and ruling out clinically significant portal hypertension is an unmet clinical need. The incorporation of spleen stiffness measurements in non-invasive algorithms using validated software and improved measuring scales might enhance the non-invasive diagnosis of portal hypertension in the next 5 years.
评估门静脉高压症存在和严重程度的金标准仍然是肝静脉压力梯度，但最近使用弹性成像技术的非侵入性评估方法提供了有价值的替代方法。在这篇综述中，我们讨论了这些技术在肝硬化引起的门静脉高压症患者中的诊断准确性和实用性。
重点对不同弹性成像技术进行了文献检索，以评估慢性肝病患者门静脉高压症和食管静脉曲张的存在和严重程度。还讨论了弹性成像与血小板计数和脾脏大小等参数相结合的情况。
肝纤维化和门静脉高压症的非侵入性评估是诊断和随访患者的有效工具。Baveno VI 建议将瞬时弹性成像和血小板计数相结合，用于排除代偿期晚期慢性肝病患者需要治疗的静脉曲张。评估病因特异性临界值以确定和排除临床显著门静脉高压症是一个未满足的临床需求。在使用经过验证的软件和改进的测量量表的非侵入性算法中纳入脾脏硬度测量值，可能会在未来 5 年内提高门静脉高压症的非侵入性诊断水平。
