Preventive strategies in hepatology: Role of multiparametric assessment of portal hypertension in chronic liver disease

Figure 4 Spleen stiffness measurement and dynamic change of spleen stiffness. A: Spleen stiffness measurement (SSM). The transient elastography (TE) SSM value < 21 kPa can rule out clinically significant portal hypertension (CSPH), while a value of more than 50 kPa confirms CSPH in patients with viral hepatitis-related compensated advanced chronic liver disease. An SSM of ≤ 40 kPa, a liver stiffness measurement of < 20 kPa, and a platelet count of ≥ 150 × 10⁹/L allow for the omission of upper endoscopy screening; B: Dynamic change of spleen stiffness. A change in SSM ≥ 10% after the initiation of nonselective beta blockers (NSBBs) demonstrates excellent accuracy in identifying NSBBs responders. A SSM of ≥ 74 kPa by TE demonstrates outstanding performance in predicting a poor response to NSBBs. SSM is essential for noninvasively monitoring transjugular intrahepatic portosystemic shunt patency and identifying dysfunction. SSM is a useful tool for early prognosis and tracking liver function after liver transplantation. ARFI: Acoustic radiation force impulse; EGD: Esophagogastroduodenoscopy; TE: Transient elastography; LSM: Liver stiffness measurement; CSPH: Clinically significant portal hypertension; NSBB: Nonselective beta blockers; SSM: Spleen stiffness measurement; TIPS: Transjugular intrahepatic portosystemic shunt; SS: Spleen stiffness.