PDF herunterladen
Digestive Disease Interventions 2022; 06(03): 249-262
DOI: 10.1055/s-0042-1749644
Review Article

Portal Pressure Measurements: Locations, Implications, and State of the Art

Sameer Gadani
1   Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
,
Hans Michell
1   Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
,
Shetal Shah
2   Department of Diagnostic Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
,
Sasan Partovi
1   Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Portal hypertension defined as pressure within the portal venous system is an important event in the evolution of cirrhosis. With the development of clinically significant portal hypertension, there is increased risk of developing gastroesophageal varices and hepatic decompensation. Endoscopic evaluation of esophageal and gastric varices and hepatic venous pressure gradient (HVPG) measurement are gold standard methods for evaluating portal hypertension. Additionally, measurement of HVPG is important in prognostication and assessing efficacy of pharmacotherapy. New state-of-the-art noninvasive techniques are available for diagnosis and assessment of portal hypertension severity. While some of these are validated for larger clinical application, others are still experimental. In this review, we have discussed invasive and noninvasive portal hypertension measurement techniques.

Keywords

portal hypertension - hepatic venous pressure gradient - elastography


Publikationsverlauf

Eingereicht: 05. Oktober 2021

Angenommen: 12. April 2022

Artikel online veröffentlicht:
27. Juni 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rajekar H, Vasishta RK, Chawla YK, Dhiman RK. Noncirrhotic portal hypertension. J Clin Exp Hepatol 2011; 1 (02) 94-108
    CrossrefPubMedGoogle Scholar
  • 2 de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001; 5 (03) 645-663
    CrossrefPubMedGoogle Scholar
  • 3 Groszmann RJ, Garcia-Tsao G, Bosch J. et al; Portal Hypertension Collaborative Group. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353 (21) 2254-2261
    CrossrefPubMedGoogle Scholar
  • 4 Bari K, Garcia-Tsao G. Treatment of portal hypertension. World J Gastroenterol 2012; 18 (11) 1166-1175
    CrossrefPubMedGoogle Scholar
  • 5 Ripoll C, Groszmann R, Garcia-Tsao G. et al; Portal Hypertension Collaborative Group. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007; 133 (02) 481-488
    CrossrefPubMedGoogle Scholar
  • 6 Bruix J, Castells A, Bosch J. et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 1996; 111 (04) 1018-1022
    CrossrefPubMedGoogle Scholar
  • 7 Ripoll C, Groszmann RJ, Garcia-Tsao G. et al; Portal Hypertension Collaborative Group. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50 (05) 923-928
    CrossrefPubMedGoogle Scholar
  • 8 Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65 (01) 310-335
    CrossrefPubMedGoogle Scholar
  • 9 García-Pagán JC, Caca K, Bureau C. et al; Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362 (25) 2370-2379
    CrossrefPubMedGoogle Scholar
  • 10 Nicoară-Farcău O, Han G, Rudler M. et al; Preemptive TIPS Individual Data Meta-analysis, International Variceal Bleeding Study and Baveno Cooperation Study groups. Effects of early placement of transjugular portosystemic shunts in patients with high-risk acute variceal bleeding: a meta-analysis of individual patient data. Gastroenterology 2021; 160 (01) 193-205.e10
    CrossrefPubMedGoogle Scholar
  • 11 Mokdad AH, Forouzanfar MH, Daoud F. et al. Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 387 (10036): 2383-2401
    CrossrefPubMedGoogle Scholar
  • 12 Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol 2019; 70 (01) 151-171
    CrossrefPubMedGoogle Scholar
  • 13 Panke WF, Bradley EG, Moreno AH, Ruzicka Jr FF, Rousselot LM. Technique, hazards, and usefulness of percutaneous splenic portography. J Am Med Assoc 1959; 169 (10) 1032-1037
    CrossrefPubMedGoogle Scholar
  • 14 Greene L, Weisberg H, Rosenthal WS, Douvres PA, Katz D. Evaluation of esophageal varices in liver disease by splenic-pulp manometry, splenoportography, and esophagogastroscopy; diagnostic discrepancies. Am J Dig Dis 1965; 10: 284-292
    CrossrefPubMedGoogle Scholar
  • 15 de Franchis R, Dell'Era A. Invasive and noninvasive methods to diagnose portal hypertension and esophageal varices. Clin Liver Dis 2014; 18 (02) 293-302
    CrossrefPubMedGoogle Scholar
  • 16 Abby Philips C, Sahney A. Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place. Gastroenterol Rep (Oxf) 2016; 4 (03) 186-195
    CrossrefPubMedGoogle Scholar
  • 17 Grant A, Neuberger J. Guidelines on the use of liver biopsy in clinical practice. Gut 1999; 45 (Suppl. 04) IV1-IV11
    PubMedGoogle Scholar
  • 18 Rösch J, Lakin PC, Antonovic R, Dotter CT. Transjugular approach to liver biopsy and transhepatic cholangiography. N Engl J Med 1973; 289 (05) 227-231
    CrossrefPubMedGoogle Scholar
  • 19 Dotter CT. Catheter biopsy. Experimental technic for transvenous liver biopsy. Radiology 1964; 82: 312-314
    CrossrefPubMedGoogle Scholar
  • 20 Hanafee W, Weiner M. Transjugular percutaneous cholangiography. Radiology 1967; 88 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 21 Behrens G, Ferral H. Transjugular liver biopsy. Semin Intervent Radiol 2012; 29 (02) 111-117
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Keshava SN, Mammen T, Surendrababu N, Moses V. Transjugular liver biopsy: what to do and what not to do. Indian J Radiol Imaging 2008; 18 (03) 245-248
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 23 Gorriz E, Reyes R, Lobrano MB. et al. Transjugular liver biopsy: a review of 77 biopsies using a spring-propelled cutting needle (biopsy gun). Cardiovasc Intervent Radiol 1996; 19 (06) 442-445
    CrossrefPubMedGoogle Scholar
  • 24 Behrens G, Ferral H, Giusto D, Patel J, Van Thiel DH. Transjugular liver biopsy: comparison of sample adequacy with the use of two automated needle systems. J Vasc Interv Radiol 2011; 22 (03) 341-345
    CrossrefPubMedGoogle Scholar
  • 25 Kalambokis G, Manousou P, Vibhakorn S. et al. Transjugular liver biopsy – indications, adequacy, quality of specimens, and complications – a systematic review. J Hepatol 2007; 47 (02) 284-294
    CrossrefPubMedGoogle Scholar
  • 26 Beckmann MG, Bahr MJ, Hadem J. et al. Clinical relevance of transjugular liver biopsy in comparison with percutaneous and laparoscopic liver biopsy. Gastroenterol Res Pract 2009; 2009: 947014
    CrossrefPubMedGoogle Scholar
  • 27 Smith TP, Kim CY, Smith AD. et al. Hepatic venous pressure measurements: comparison of end-hole and balloon catheter methods. J Vasc Interv Radiol 2012; 23 (02) 219-26.e6
    CrossrefPubMedGoogle Scholar
  • 28 Chelliah ST, Keshava SN, Moses V, Surendrababu NR, Zachariah UG, Eapen C. Measurement of hepatic venous pressure gradient revisited: catheter wedge vs balloon wedge techniques. Indian J Radiol Imaging 2011; 21 (04) 291-293
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 29 Maleux G, Willems E, Fieuws S. et al. Prospective study comparing different indirect methods to measure portal pressure. J Vasc Interv Radiol 2011; 22 (11) 1553-1558
    CrossrefPubMedGoogle Scholar
  • 30 Bosch J, Garcia-Pagán JC, Berzigotti A, Abraldes JG. Measurement of portal pressure and its role in the management of chronic liver disease. Semin Liver Dis 2006; 26 (04) 348-362
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 D'Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006; 131 (05) 1611-1624
    Google Scholar
  • 32 Sanyal AJ, Friedman SL, McCullough AJ, Dimick-Santos L. American Association for the Study of Liver Diseases, United States Food and Drug Administration, Food and Drug Administration Joint Workshop. Challenges and opportunities in drug and biomarker development for nonalcoholic steatohepatitis: findings and recommendations from an American Association for the Study of Liver Diseases-U.S. Hepatology 2015; 61 (04) 1392-1405
    CrossrefPubMedGoogle Scholar
  • 33 La Mura V, Abraldes JG, Berzigotti A. et al. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study. Hepatology 2010; 51 (06) 2108-2116
    CrossrefPubMedGoogle Scholar
  • 34 Silva-Junior G, Baiges A, Turon F. et al. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology 2015; 62 (05) 1584-1592
    CrossrefPubMedGoogle Scholar
  • 35 Rössle M, Blanke P, Fritz B, Schultheiss M, Bettinger D. Free hepatic vein pressure is not useful to calculate the portal pressure gradient in cirrhosis: a morphologic and hemodynamic study. J Vasc Interv Radiol 2016; 27 (08) 1130-1137
    CrossrefPubMedGoogle Scholar
  • 36 Fagiuoli S, Bruno R, Debernardi Venon W. et al; AISF TIPS Special Conference. Consensus conference on TIPS management: techniques, indications, contraindications. Dig Liver Dis 2017; 49 (02) 121-137
    CrossrefPubMedGoogle Scholar
  • 37 Boike J, Thornburg B, Asrani S. et al. North American Practice-based recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension. Clin Gastroenterol Hepatol 2021:S1542-3565(21)00749-7
    PubMedGoogle Scholar
  • 38 Vorobioff J, Groszmann RJ, Picabea E. et al. Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study. Gastroenterology 1996; 111 (03) 701-709
    CrossrefPubMedGoogle Scholar
  • 39 Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 2006; 43 (02, Suppl 1): S121-S131
    CrossrefPubMedGoogle Scholar
  • 40 Casado M, Bosch J, García-Pagán JC. et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998; 114 (06) 1296-1303
    CrossrefPubMedGoogle Scholar
  • 41 D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44 (01) 217-231
    CrossrefPubMedGoogle Scholar
  • 42 Ripoll C, Bañares R, Rincón D. et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era. Hepatology 2005; 42 (04) 793-801
    CrossrefPubMedGoogle Scholar
  • 43 Berzigotti A, Rossi V, Tiani C. et al. Prognostic value of a single HVPG measurement and Doppler-ultrasound evaluation in patients with cirrhosis and portal hypertension. J Gastroenterol 2011; 46 (05) 687-695
    CrossrefPubMedGoogle Scholar
  • 44 Moitinho E, Escorsell A, Bandi JC. et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology 1999; 117 (03) 626-631
    CrossrefPubMedGoogle Scholar
  • 45 Monescillo A, Martínez-Lagares F, Ruiz-del-Arbol L. et al. Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding. Hepatology 2004; 40 (04) 793-801
    CrossrefPubMedGoogle Scholar
  • 46 Berzigotti A, Gilabert R, Abraldes JG. et al. Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis. Am J Gastroenterol 2008; 103 (05) 1159-1167
    CrossrefPubMedGoogle Scholar
  • 47 Qamar AA, Grace ND, Groszmann RJ. et al; Portal Hypertension Collaborative Group. Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis. Clin Gastroenterol Hepatol 2009; 7 (06) 689-695
    CrossrefPubMedGoogle Scholar
  • 48 Berzigotti A, Seijo S, Arena U. et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology 2013; 144 (01) 102-111.e1
    CrossrefPubMedGoogle Scholar
  • 49 Procopet B, Berzigotti A. Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterol Rep (Oxf) 2017; 5 (02) 79-89
    CrossrefPubMedGoogle Scholar
  • 50 Castéra L, Le Bail B, Roudot-Thoraval F. et al. Early detection in routine clinical practice of cirrhosis and oesophageal varices in chronic hepatitis C: comparison of transient elastography (FibroScan) with standard laboratory tests and non-invasive scores. J Hepatol 2009; 50 (01) 59-68
    CrossrefPubMedGoogle Scholar
  • 51 Sheth SG, Flamm SL, Gordon FD, Chopra S. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol 1998; 93 (01) 44-48
    CrossrefPubMedGoogle Scholar
  • 52 Wai CT, Greenson JK, Fontana RJ. et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38 (02) 518-526
    CrossrefPubMedGoogle Scholar
  • 53 Corpechot C, Carrat F, Poujol-Robert A. et al. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis. Hepatology 2012; 56 (01) 198-208
    CrossrefPubMedGoogle Scholar
  • 54 Kim BK, Kim DY, Park JY. et al. Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. Liver Int 2010; 30 (04) 546-553
    CrossrefPubMedGoogle Scholar
  • 55 Sterling RK, Lissen E, Clumeck N. et al; APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006; 43 (06) 1317-1325
    CrossrefPubMedGoogle Scholar
  • 56 Lichtinghagen R, Pietsch D, Bantel H, Manns MP, Brand K, Bahr MJ. The Enhanced Liver Fibrosis (ELF) score: normal values, influence factors and proposed cut-off values. J Hepatol 2013; 59 (02) 236-242
    CrossrefPubMedGoogle Scholar
  • 57 Lucidarme D, Foucher J, Le Bail B. et al. Factors of accuracy of transient elastography (Fibroscan) for the diagnosis of liver fibrosis in chronic hepatitis C. Hepatology 2009; 49 (04) 1083-1089
    CrossrefPubMedGoogle Scholar
  • 58 Naveau S, Gaudé G, Asnacios A. et al. Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease. Hepatology 2009; 49 (01) 97-105
    CrossrefPubMedGoogle Scholar
  • 59 Zarski JP, Sturm N, Guechot J. et al; ANRS HCEP 23 Fibrostar Group. Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study. J Hepatol 2012; 56 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 60 Sandrin L, Fourquet B, Hasquenoph JM. et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29 (12) 1705-1713
    CrossrefPubMedGoogle Scholar
  • 61 Perri RE, Chiorean MV, Fidler JL. et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology 2008; 47 (05) 1587-1594
    CrossrefPubMedGoogle Scholar
  • 62 Kim YJ, Raman SS, Yu NC, To'o KJ, Jutabha R, Lu DS. Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR Am J Roentgenol 2007; 188 (01) 139-144
    CrossrefPubMedGoogle Scholar
  • 63 Matsuo M, Kanematsu M, Kim T. et al. Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage. AJR Am J Roentgenol 2003; 180 (02) 461-466
    CrossrefPubMedGoogle Scholar
  • 64 Lipp MJ, Broder A, Hudesman D. et al. Detection of esophageal varices using CT and MRI. Dig Dis Sci 2011; 56 (09) 2696-2700
    CrossrefPubMedGoogle Scholar
  • 65 Yu NC, Margolis D, Hsu M, Raman SS, Lu DS. Detection and grading of esophageal varices on liver CT: comparison of standard and thin-section multiplanar reconstructions in diagnostic accuracy. AJR Am J Roentgenol 2011; 197 (03) 643-649
    CrossrefPubMedGoogle Scholar
  • 66 Goshima S, Kanematsu M, Kondo H. et al. Detection and grading for esophageal varices in patients with chronic liver damage: comparison of gadolinium-enhanced and unenhanced steady-state coherent MR images. Magn Reson Imaging 2009; 27 (09) 1230-1235
    CrossrefPubMedGoogle Scholar
  • 67 Tarantino G, Citro V, Conca P. et al. What are the implications of the spontaneous spleno-renal shunts in liver cirrhosis?. BMC Gastroenterol 2009; 9: 89
    CrossrefPubMedGoogle Scholar
  • 68 Simón-Talero M, Roccarina D, Martínez J. et al; Baveno VI-SPSS group from the Baveno Cooperation. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis. Gastroenterology 2018; 154 (06) 1694-1705.e4
    CrossrefPubMedGoogle Scholar
  • 69 Praktiknjo M, Simón-Talero M, Römer J. et al; Baveno VI-SPSS Group of the Baveno Cooperation. Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis. J Hepatol 2020; 72 (06) 1140-1150
    CrossrefPubMedGoogle Scholar
  • 70 Zironi G, Gaiani S, Fenyves D, Rigamonti A, Bolondi L, Barbara L. Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension. J Hepatol 1992; 16 (03) 298-303
    CrossrefPubMedGoogle Scholar
  • 71 Mueller S, Sandrin L. Liver stiffness: a novel parameter for the diagnosis of liver disease. Hepat Med 2010; 2: 49-67
    CrossrefPubMedGoogle Scholar
  • 72 Zhang YN, Fowler KJ, Ozturk A. et al. Liver fibrosis imaging: a clinical review of ultrasound and magnetic resonance elastography. J Magn Reson Imaging 2020; 51 (01) 25-42
    CrossrefPubMedGoogle Scholar
  • 73 Bruha R, Jachymova M, Petrtyl J. et al. Osteopontin: a non-invasive parameter of portal hypertension and prognostic marker of cirrhosis. World J Gastroenterol 2016; 22 (12) 3441-3450
    CrossrefPubMedGoogle Scholar
  • 74 Kennedy P, Bane O, Hectors SJ. et al. Noninvasive imaging assessment of portal hypertension. Abdom Radiol (NY) 2020; 45 (11) 3473-3495
    CrossrefPubMedGoogle Scholar
  • 75 de Franchis R, Baveno VI. Baveno VI Faculty. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63 (03) 743-752
    CrossrefPubMedGoogle Scholar
  • 76 Castéra L, Foucher J, Bernard PH. et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology 2010; 51 (03) 828-835
    PubMedGoogle Scholar
  • 77 Barr RG, Ferraioli G, Palmeri ML. et al. Elastography assessment of liver fibrosis: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 2015; 276 (03) 845-861
    CrossrefPubMedGoogle Scholar
  • 78 Hu X, Qiu L, Liu D, Qian L. Acoustic radiation force impulse (ARFI) elastography for non–invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis. Med Ultrason 2017; 19 (01) 23-31
    CrossrefPubMedGoogle Scholar
  • 79 Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control 2004; 51 (04) 396-409
    CrossrefPubMedGoogle Scholar
  • 80 Jiang T, Tian G, Zhao Q. et al. Diagnostic accuracy of 2D-shear wave elastography for liver fibrosis severity: a meta-analysis. PLoS One 2016; 11 (06) e0157219
    CrossrefPubMedGoogle Scholar
  • 81 Tada T, Kumada T, Toyoda H. et al. Improvement of liver stiffness in patients with hepatitis C virus infection who received direct-acting antiviral therapy and achieved sustained virological response. J Gastroenterol Hepatol 2017; 32 (12) 1982-1988
    CrossrefPubMedGoogle Scholar
  • 82 Fang C, Sidhu PS. Ultrasound-based liver elastography: current results and future perspectives. Abdom Radiol (NY) 2020; 45 (11) 3463-3472
    CrossrefPubMedGoogle Scholar
  • 83 Augustin S, Pons M, Maurice JB. et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology 2017; 66 (06) 1980-1988
    CrossrefPubMedGoogle Scholar
  • 84 Barr RG, Wilson SR, Rubens D, Garcia-Tsao G, Ferraioli G. Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement. Radiology 2020; 29 (02) 6 :263–274
    PubMedGoogle Scholar
  • 85 Berzigotti A. Non-invasive evaluation of portal hypertension using ultrasound elastography. J Hepatol 2017; 67 (02) 399-411
    CrossrefPubMedGoogle Scholar
  • 86 Zeng J, Zheng J, Jin JY. et al. Shear wave elastography for liver fibrosis in chronic hepatitis B: adapting the cut-offs to alanine aminotransferase levels improves accuracy. Eur Radiol 2019; 29 (02) 857-865
    CrossrefPubMedGoogle Scholar
  • 87 Cunha GM, Glaser KJ, Bergman A, Luz RP, de Figueiredo EH, Lobo Lopes FPP. Feasibility and agreement of stiffness measurements using gradient-echo and spin-echo MR elastography sequences in unselected patients undergoing liver MRI. Br J Radiol 2018; 91 (1087): 20180126
    CrossrefPubMedGoogle Scholar
  • 88 Hoodeshenas S, Yin M, Venkatesh SK. Magnetic resonance elastography of liver: Current update. Top Magn Reson Imaging 2018; 27 (05) 319-333
    CrossrefPubMedGoogle Scholar
  • 89 Yin M, Talwalkar JA, Glaser KJ. et al. Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 2007; 5 (10) 1207-1213.e2
    CrossrefPubMedGoogle Scholar
  • 90 Chou CT, Chen RC, Wu WP, Lin PY, Chen YL. Prospective comparison of the diagnostic performance of magnetic resonance elastography with acoustic radiation force impulse elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. Ultrasound Med Biol 2017; 43 (12) 2783-2790
    CrossrefPubMedGoogle Scholar
  • 91 Morisaka H, Motosugi U, Glaser KJ. et al. Comparison of diagnostic accuracies of two- and three-dimensional MR elastography of the liver. J Magn Reson Imaging 2017; 45 (04) 1163-1170
    CrossrefPubMedGoogle Scholar
  • 92 Kim MY, Baik SK, Park DH. et al. Damping index of Doppler hepatic vein waveform to assess the severity of portal hypertension and response to propranolol in liver cirrhosis: a prospective nonrandomized study. Liver Int 2007; 27 (08) 1103-1110
    CrossrefPubMedGoogle Scholar
  • 93 Bolognesi M, Sacerdoti D, Merkel C, Bombonato G, Gatta A. Noninvasive grading of the severity of portal hypertension in cirrhotic patients by echo-color-Doppler. Ultrasound Med Biol 2001; 27 (07) 901-907
    CrossrefPubMedGoogle Scholar
  • 94 Maruyama H, Shiha G, Yokosuka O. et al. Non-invasive assessment of portal hypertension and liver fibrosis using contrast-enhanced ultrasonography. Hepatol Int 2016; 10 (02) 267-276
    CrossrefPubMedGoogle Scholar
  • 95 Eisenbrey JR, Dave JK, Halldorsdottir VG. et al. Chronic liver disease: noninvasive subharmonic aided pressure estimation of hepatic venous pressure gradient. Radiology 2013; 268 (02) 581-588
    CrossrefPubMedGoogle Scholar
  • 96 Amat-Roldan I, Berzigotti A, Gilabert R, Bosch J. Assessment of hepatic vascular network connectivity with automated graph analysis of dynamic contrast-enhanced US to evaluate portal hypertension in patients with cirrhosis: a pilot study. Radiology 2015; 277 (01) 268-276
    CrossrefPubMedGoogle Scholar
  • 97 Berzigotti A, Piscaglia F, Amat-Roldan I. et al. Non-invasive measurement of HVPG using graph analysis of dynamic contrast-enhanced ultrasound: the CLEVER study. J Hepatol 2018; 68 (01) S76-S77
    CrossrefPubMedGoogle Scholar
  • 98 Hagiwara M, Rusinek H, Lee VS. et al. Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging – initial experience. Radiology 2008; 246 (03) 926-934
    CrossrefPubMedGoogle Scholar
  • 99 Dyvorne HA, Jajamovich GH, Bane O. et al. Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection. Liver Int 2016; 36 (05) 659-666
    CrossrefPubMedGoogle Scholar
  • 100 Wagner M, Hectors S, Bane O. et al. Noninvasive prediction of portal pressure with MR elastography and DCE-MRI of the liver and spleen: preliminary results. J Magn Reson Imaging 2018; 48 (04) 1091-1103
    CrossrefPubMedGoogle Scholar
  • 101 Annet L, Materne R, Danse E, Jamart J, Horsmans Y, Van Beers BE. Hepatic flow parameters measured with MR imaging and Doppler US: correlations with degree of cirrhosis and portal hypertension. Radiology 2003; 229 (02) 409-414
    CrossrefPubMedGoogle Scholar
  • 102 Hectors SJ, Bane O, Kennedy P. et al. Noninvasive diagnosis of portal hypertension using gadoxetate DCE-MRI of the liver and spleen. Eur Radiol 2021; 31 (07) 4804-4812
    CrossrefPubMedGoogle Scholar
  • 103 Patel J, Sigmund EE, Rusinek H, Oei M, Babb JS, Taouli B. Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast-enhanced MRI alone and in combination: preliminary experience. J Magn Reson Imaging 2010; 31 (03) 589-600
    CrossrefPubMedGoogle Scholar