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

Figure 6 Multiparametric ultrasound-based algorithm for noninvasive risk stratification of compensated advanced liver disease and clinically significant portal hypertension and linkage to preventive interventions. Proposed stepwise decision algorithm for ambulatory patients with compensated advanced liver disease. Step 1: Baseline multiparametric ultrasonography, including B-mode and Doppler ultrasound, along with routine blood tests with platelet count as a surrogate of portal hypertension. Step 2: Liver stiffness measurement and spleen stiffness measurement. Step 3: Risk stratification into low risk, gray zone/indeterminate risk, and high risk. Step 4: Associated preventive outputs, including initiation of nonselective beta blockers and/or endoscopy with intensified follow-up for patients with confirmed clinically significant portal hypertension. PLT: Platelet; CSPH: Clinically significant portal hypertension; SSM: Spleen stiffness measurement; LSM: Liver stiffness measurement; NSBBs: Nonselective beta blockers; cACLD: Compensated advanced chronic liver disease; CEUS: Contrast-enhanced ultrasound; MPUS: Multiparametric ultrasound; TE: Transient elastography.