Portal hypertension (PH) is one of the most serious complications of chronic liver disease. It occurs when pressure rises in the portal vein, which carries blood from the digestive organs to the liver. As the condition progresses, patients face an increased risk of life-threatening complications, including variceal hemorrhage, spontaneous bacterial peritonitis, and hepatorenal syndrome. In untreated patients with esophageal variceal bleeding, the 5-year survival rate remains below 50%, underscoring the importance of timely diagnosis and treatment.
Diagnosing PH, however, remains a challenge. The current gold standard is the hepatic venous pressure gradient (HVPG), an invasive procedure that directly measures pressure within the liver using a catheter. Although highly accurate, HVPG is expensive, technically demanding, and available mainly in specialized medical centers, making routine use difficult. These limitations have driven the search for non-invasive methods that can detect PH earlier and monitor disease progression without subjecting patients to invasive procedures.
A new review made available online in Portal Hypertension & Cirrhosis journal on July 23, 2026, examines the latest advances in non-invasive approaches for diagnosing PH and discusses how emerging technologies could improve clinical care. The review was led by Dr. Ling Yang from the Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China. "Recent advances in non-invasive diagnostic technologies are expanding the options available for assessing PH," says Dr. Yang. "Continued refinement and standardization of these approaches could improve early detection and support clinical decision-making."
To provide a comprehensive overview of the field, the researchers studied evidence on a broad range of diagnostic strategies. These include elastography techniques—such as transient elastography, shear wave elastography, and magnetic resonance elastography—which measure liver and spleen stiffness as indirect indicators of portal pressure. The review also examines biochemical markers, including platelet count; imaging measurements such as liver stiffness and spleen diameter; and composite diagnostic tools such as the Baveno VII criteria. In addition, the authors discuss how artificial intelligence (AI) and machine learning are enabling predictive models that combine clinical, laboratory, and imaging data to improve diagnostic performance.
The review highlights that no single non-invasive technique provides all the information needed to diagnose PH. Instead, each approach contributes different insights into the disease. Elastography technologies have demonstrated high sensitivity and specificity for detecting early-stage PH while avoiding the risks associated with catheter-based procedures. Blood-based biomarkers and imaging findings provide additional information that can help clinicians assess disease severity and identify patients at higher risk of complications. The Baveno VII criteria further support clinical decision-making by identifying patients who are unlikely to have clinically significant PH, helping some individuals avoid unnecessary endoscopic examinations.
The researchers also describe AI as an emerging tool that could strengthen non-invasive diagnosis. By integrating multiple sources of patient information—including clinical characteristics, laboratory results, and imaging findings—AI- and machine learning-based models may provide more accurate and individualized risk assessments than any single test alone. Although many of these models are still being validated, they represent an important step toward more precise and efficient diagnosis.
Despite these advances, the review emphasizes that non-invasive approaches should currently be viewed as complementary rather than replacements for HVPG. Combining different diagnostic methods may provide a more comprehensive evaluation of PH, allowing clinicians to detect the disease earlier, monitor changes over time, and tailor treatment according to each patient's condition.
"No single non-invasive method can currently replace the diagnostic gold standard in every clinical setting," Dr. Yang adds. "However, integrating imaging techniques, biomarkers, and predictive models may provide a more comprehensive approach to evaluating PH and guiding patient management."
In conclusion, as these technologies continue to evolve and become more standardized, non-invasive diagnostic strategies are expected to play an increasingly important role in the early detection and management of PH. By making diagnosis safer, more accessible, and more patient-friendly, they could help improve outcomes for people living with chronic liver disease while reducing reliance on invasive procedures.
Reference
DOI: https://doi.org/10.1002/poh2.70060
About Huazhong University of Science and Technology, China
Huazhong University of Science and Technology (HUST) is a leading comprehensive research university in Wuhan, China, directly supervised by the Ministry of Education. Recognized under China's "Double First-Class" Initiative, HUST consistently ranks among the country's top universities in major national and international rankings. With strengths in engineering, medicine, science, and the liberal arts, the university is home to over 55,000 students and 3,400 faculty members. HUST is also distinguished for its four national research facilities and strong emphasis on innovation, interdisciplinary research, and international collaboration.
Website: https://english.hust.edu.cn/
About Dr. Ling Yang from Huazhong University of Science and Technology, China
Dr. Ling Yang, MD, PhD, is Chief Physician in the Division of Gastroenterology at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), China. A clinician-scientist with over two decades of experience in gastroenterology and hepatology, her research focuses on liver diseases, including liver fibrosis, metabolic dysfunction-associated steatotic liver disease (MASLD/formerly NASH), liver cancer, portal hypertension, lipid metabolism, TGF-β signaling, and Toll-like receptor pathways. Dr. Yang has authored more than 146 scientific publications, which have received over 5,800 citations, reflecting her significant contributions to liver disease research and translational medicine.
