Non-invasive Measurement of Portal Pressure

  • Ahmed M. Elmahdy
  • Annalisa BerzigottiEmail author
Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Management of the Cirrhotic Patient


Purpose of Review

To provide an updated overview of the existing and emerging non-invasive diagnostic methods to assess portal hypertension.

Recent Findings

Data on liver stiffness measurement confirmed that it is a mainstay for assessing the risk of clinically significant portal hypertension in patients with advanced chronic liver disease of any etiology. The Baveno criteria for identifying patients who can safely spare endoscopy have been validated in NASH and cholestatic liver disease. New expanded criteria and other simple non-invasive algorithms including MELD score or spleen stiffness have been proposed and can lead to a higher proportion of endoscopies without significantly increasing the risk of missing large esophageal varices. MR and CT improve the anatomical imaging of gastroesophageal varices and abdominal collaterals and dynamic imaging based on MR and able to quantify hepatic blood flow are in development. Contrast-enhanced ultrasound and methacetin breath test are emerging promising methods to estimate the HVPG non-invasively.


Several different non-invasive methods are now available and can be used in clinical practice to achieve a successful identification of patients with clinically significant portal hypertension in chronic liver disease. However, an exact estimation of HVPG is not available yet, and changes in portal pressure cannot yet be detected by non-invasive methods.


Liver cirrhosis Ultrasound Elastography Magnetic resonance CEUS 


Compliance with Ethical Standards

Conflict of Interest

Ahmed M.Elmahdy and Annalisa Berzigotti each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Mansoura Faculty of MedicineMansouraEgypt
  2. 2.Hepatology, University Clinic for Visceral Surgery and Medicine, InselspitalUniversity of BernBernSwitzerland

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