Table 2.

Noninvasive Imaging Modalities for Assessing Clinically Significant Portal Hypertension

Assessment method	Sensitivity (95% CI)	Specificity (95% CI)	Pros	Cons
CT/MRI96	0.77 (0.71–0.82)	0.81 (0.73–0.87)	Available at several hospitals	Exposure to radiation in CT
			Useful for collateral blood vessel detection	Risk of allergy or nephropathy due to contrast agents
TE-based LSM96	0.81 (0.73–0.87)	0.83 (0.77–0.88)	Available at several hospitals	Somewhat dependent on the skill of the operator
			Rapidity	Affected by liver inflammation and cholestasis
			Easy and reproducible	Not measurable in patients with obesity or ascites
			Validated in several etiologies
SWE-based LSM96	0.77 (0.71–0.82)	0.76 (0.65–0.84)	Rapidity	Dependent on the skill of the operator
			Repeatable and reproducible	Affected by liver inflammation and cholestasis
			Not limited by ascites
US-based SSM97	0.85 (0.69–0.93)	0.86 (0.74–0.93)	Less influenced by liver inflammation	A dedicated device is required
			Reflects not only increased intrahepatic vascular resistance but also splenic hemodynamics and fibrosis	Difficult to measure without splenomegaly
MRI-based LSM98	0.83 (0.72–0.90)	0.80 (0.70–0.88)	Capable of covering the whole liver	Expensive modality
			Less operator dependence	Not universally applied in clinical practice
			High reproducibility	Affected by liver inflammation and cholestasis
MRI-based SSM98	0.79 (0.61–0.90)	0.90 (0.80–0.95)	Capable of covering the whole spleen	Expensive modality
			Less operator dependence	Not universally applied in clinical practice
			High reproducibility	Complexity of repositioning the passive driver from the liver to the spleen

CI, confidence interval; CT, computed tomography; MRI, magnetic resonance imaging; TE, transient elastography; LSM, liver stiffness measurement; SWE, shear wave elastography; US, ultrasound; SSM, spleen stiffness measurement.