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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11542-11551
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11542
Ultrasound-based elastography for the diagnosis of portal hypertension in cirrhotics
Roxana Şirli, Ioan Sporea, Alina Popescu, Mirela Dănilă
Roxana Şirli, Ioan Sporea, Alina Popescu, Mirela Dănilă, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300736 Timişoara, Romania
Author contributions: Şirli R designed the research regarding the paper and wrote the manuscript; Şirli R, Sporea I, Popescu A and Dănilă M performed research; Sporea I, Popescu A and Dănilă M revised and completed the manuscript; all authors approved the final version of the manuscript.
Conflict-of-interest statement: None of the authors have any conflicts of interest regarding this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roxana Şirli, MD, PhD, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 10, Iosif Bulbuca Bv., 300736 Timişoara, Romania. roxanasirli@gmail.com
Telephone: +40-723-537039 Fax: +40-256-488003
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: July 11, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: November 7, 2015
Abstract

Progressive fibrosis is encountered in almost all chronic liver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks (inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis (serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasound-based elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography (TE) and acoustic radiation force impulse (ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shear-wave elastography, the ElastPQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.

Keywords: Portal hypertension, Transient elastography, Acoustic radiation force impulse elastography, Two-dimensional shear-wave elastography

Core tip: Ultrasound-based elastographic methods are being used more and more for the non-invasive assessment of liver fibrosis, with very good accuracy in diagnosing cirrhosis. Transient elastography is a promising method for predicting portal hypertension in cirrhotics, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of employing acoustic radiation force impulse elastography in the liver to predict portal hypertension is debatable. It may be significantly increased if spleen stiffness is assessed, whether alone or in combination with liver stiffness and other parameters. Two-dimensional shear-wave elastography, the ElastPQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.