Advances in Precise Assessment of Portal Pressure in Porto-sinusoidal Vascular Disease (IMAGE)
Caption
Precise portal pressure assessment is increasingly driving precision management in PSVD. The diagnostic paradigm has shifted from exclusion-based criteria to the PSVD concept centered on specific vascular lesions, while assessment has evolved from reliance on invasive HVPG to a stratified strategy led by multimodal non-invasive tools and supported by minimally invasive methods. Ultrasound elastography identifies the characteristic liver–spleen stiffness dissociation pattern, and CT/MRI radiomics further enable non-invasive quantitative pressure modeling.
Future research will move toward non-invasiveness, digitalization, and intelligent systems. Standardization of EUS-PPG and emerging tools such as sublingual vein imaging may improve direct or surrogate pressure assessment. Meanwhile, AI integrating clinical, imaging, and multi-omics data may enable precise subtyping and dynamic prognostic prediction of complications.
Ultimately, combining optimized pressure assessment with data-driven precision stratification will enable more individualized interventions and improve survival in PSVD patients.
Collectively, these advances may facilitate the transition from conventional portal hypertension assessment toward precision-guided management in PSVD.
Credit
Qingchun Fu, Muyun Liu
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CC BY-NC