Noninvasive imaging assessment of portal hypertension
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SPECIAL SECTION: DIFFUSE LIVER DISEASE.
Noninvasive imaging assessment of portal hypertension Paul Kennedy1 · Octavia Bane1 · Stefanie J. Hectors1,2 · Aaron Fischman3 · Thomas Schiano4 · Sara Lewis1,3 · Bachir Taouli1,3 Received: 11 May 2020 / Revised: 16 August 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Portal hypertension (PH) is a spectrum of complications of chronic liver disease (CLD) and cirrhosis, with manifestations including ascites, gastroesophageal varices, splenomegaly, hypersplenism, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. PH can vary in severity and is diagnosed via invasive hepatic venous pressure gradient measurement (HVPG), which is considered the reference standard. Accurate diagnosis of PH and assessment of severity are highly relevant as patients with clinically significant portal hypertension (CSPH) are at higher risk for developing acute variceal bleeding and mortality. In this review, we discuss current and upcoming noninvasive imaging methods for diagnosis and assessment of severity of PH. Keywords Portal hypertension · Cirrhosis · Elastography · Stiffness · MRI Abbreviations ALT Alanine aminotransferase APRI AST-to-platelet ratio index AST Aspartate aminotransferase cACLD Compensated advanced chronic liver disease CLD Chronic liver disease CP Child–Pugh CSPH Clinically significant portal hypertension CT Computed tomography ECV Extracellular volume fraction HABR Hepatic arterial buffer response HVPG Hepatic venous pressure gradient Paul Kennedy and Octavia Bane have contributed equally to this work. * Bachir Taouli [email protected] 1
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
2
Department of Radiology, Weill Cornell Medicine, New York, NY, USA
3
Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
4
Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
INR International normalized ratio LS Liver stiffness MELD Model for end-stage liver disease MRE Magnetic resonance elastography MRI Magnetic resonance imaging PH Portal hypertension PV Portal vein SS Spleen stiffness TE Transient elastography US Ultrasound
Introduction/Background Chronic liver disease (CLD) results from hepatocyte damage due to a variety of insults and, if left untreated, may result in liver fibrosis and cirrhosis. CLD and cirrhosis are the 8th leading cause of death in the USA, resulting in at least 34,000 deaths annually and there has been a recent 65% increase in death rate from 1996 to 2006, estimates of which are most likely conservative [1–3]. Furthermore, deaths due to cirrhosis are anticipated to triple by 2030, due to the increasing prevalence of NAFLD [4]. Typical etiologies
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