Diagnostic Accuracy of Liver and Spleen Elastography for Detecting Portal Hypertension Defined by Hepatic Venous Pressure Gradient (HVPG) in Chronic Liver Disease: A Systematic Review.

Portal hypertension is a major consequence of chronic liver disease and a key determinant of clinical outcomes, traditionally assessed using the invasive hepatic venous pressure gradient (HVPG). Given the limitations of HVPG measurement, ultrasound-based elastography has emerged as a promising noninvasive alternative. This systematic review evaluated the diagnostic accuracy of liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), obtained through transient elastography (TE) and shear-wave elastography (SWE), for detecting HVPG-defined portal hypertension in adults with chronic liver disease. A comprehensive search of PubMed/MEDLINE, Embase, and the Cochrane Library, from database inception through December 2024, identified eight eligible studies comprising 1,636 patients. Clinically significant portal hypertension was primarily defined as an HVPG of ≥10 mmHg. Across studies, LSM demonstrated moderate-to-high discriminatory performance, with area under the receiver operating characteristic curve (AUROC) values ranging from 0.74 to 0.94, depending on modality and population. SWE generally showed superior performance compared with conventional TE, particularly when standardized reliability criteria were applied. SSM provided complementary hemodynamic information and improved risk stratification in selected cohorts, although it did not consistently outperform LSM alone. Variability in stiffness cutoffs and study design contributed to methodological heterogeneity. Overall, ultrasound-based elastography demonstrates clinically meaningful diagnostic accuracy for identifying portal hypertension and offers a practical, noninvasive approach for risk stratification, particularly in compensated cirrhosis; however, it does not fully replace invasive HVPG measurement.