Assessment and prediction of clinically significant portal hypertension = Assessment and prediction of clinically significant portal hypertension

다국어 초록 (Multilingual Abstract)

Clinically significant portal hypertension (CSPH) is one of critical point in compensated cirrhosis that can predict the risk of the progression to decompensation and development of hepatocellular carcinoma. In general, CSPH defined as the hepatic venous pressure gradient (HVPG) more than 10mmHg and in clinical situation the development of varices also can be accepted as CSPH. The gold standard to estimate CSPH is the measurement of HVPG however, it is invasive and have limitations in routine clinical application. Ultrasound (US) is simple, safe and repeatable in bedside so, Doppler US indices have been tried to estimate the hemodynamic changes and medical treatment response non-invasively. Even though many positive evidences, its clinical usefulness in PH has still controversy because of lacking of reproducibility and intra- and inter-observer variation. Hepatic vein arrival time and hepatic vein transit time using microbubble contrast-enhanced US (CEUS) get shorter according to the severity of disease and show good correlation with HVPG. The liver and spleen stiffness measurement using US based elastography such as vibration controlled transient elastography or other type swear wave elastography are one of the most charming candidate for non-invasive evaluation of CSPH. The combination with platelet count or spleen size improved their ability to estimate CSPH. Magnetic resonance elastography (MRE) has been proposed as a method to evaluate both liver and spleen stiffness, overcoming some of the limitations of ultrasound based elastography. This report briefly reviewed invasive and non-invasive method to estimate CSPH.