Portal hypertension (PH), a serious complication of liver cirrhosis, is defined as a pressure gradient greater than 5 mmHg between the portal vein and the inferior vena cava. When the hepatic venous pressure gradient (HVPG) exceeds 10 mmHg, the condition becomes clinically significant and complications are significantly increased, making early detection important to guide treatment.
Recent reviews were available online on March 1, 2025 and published on March 17, 2025. Portal hypertension and cirrhosis This journal investigates whether advances in ultrasound technology can provide a reliable, non-invasive method to assess PH.
PH develops when cirrhosis increases the resistance to blood flow through the liver, increasing pressure in the portal venous system. This review describes how different ultrasound techniques can detect these changes.
Conventional B-mode ultrasound can reveal structural features of cirrhosis, such as a nodular liver surface, altered liver shape, and enlarged blood vessels, as well as indirect signs of PH, such as splenomegaly and ascites.
Doppler ultrasound allows clinicians to assess the direction and velocity of blood flow within the portal vein and surrounding blood vessels. In liver cirrhosis, portal vein flow often slows and in severe cases may reverse direction. This is a pattern known as hepatic floating flow, which indicates that PH is progressing.
Clinicians evaluate multiple ultrasound parameters together, as no single measurement provides a complete picture of disease severity. This approach is known as multiparameter ultrasound.
Elastography, another method discussed in this review, measures liver stiffness as an indicator of fibrosis progression and PH severity.
The researchers are also focusing on contrast-enhanced ultrasound, which characterizes blood flow in the liver by tracking contrast agents injected through the hepatic blood vessels. However, individual differences in flow patterns and collateral vessel development can complicate interpretation.
Although ultrasound cannot yet completely replace invasive manometry, multiparametric ultrasound provides a practical, non-invasive alternative that may help clinicians better understand the complex changes that occur in liver disease and support both patient monitoring and clinical decision-making.
Of note, this study also provides scenario-specific ultrasound recommendations, adding practical value for clinicians and researchers.
sauce:
China Medical Association Publishing Co., Ltd.
Reference magazines:
Mellor, K. others. (2025). Portal hypertension – non-invasive multiparametric ultrasound-based criteria and measurements. Portal hypertension and cirrhosis. DOI: 10.1002/poh2.70002. https://onlinelibrary.wiley.com/doi/10.1002/poh2.70002
