Diagnosis of Portal Hypertension: Advancing Towards Non‐Invasive Solutions

ABSTRACT Portal hypertension (PH) is a clinical syndrome characterized by elevated portal venous pressure and represents a major complication of chronic liver disease. It serves as the underlying cause of several life‐threatening conditions, including variceal hemorrhage, spontaneous bacterial peritonitis, and hepatorenal syndrome. In untreated patients—particularly those with esophageal variceal bleeding—the 5‐year survival rate remains below 50%, underscoring the urgent need for early, reliable, and accessible diagnostic methods. Although invasive techniques such as hepatic venous pressure gradient (HVPG) measurement are considered the diagnostic gold standard, their high cost, procedural risk, and limited availability restrict their widespread clinical application. Consequently, non‐invasive diagnostic approaches have gained increasing attention. Recent progress in elastography technologies—including transient elastography (TE), shear wave elastography (SWE), and magnetic resonance elastography (MRE)—has demonstrated excellent sensitivity and specificity in detecting early‐stage PH. Moreover, biochemical indicators such as platelet count (PLT), imaging metrics including spleen diameter and liver stiffness, along with composite criteria like the Baveno VII guidelines, have significantly improved diagnostic accuracy. Imaging advancements have further contributed to the expansion of non‐invasive assessment strategies. Importantly, the integration of artificial intelligence (AI) and machine learning techniques has enabled the creation of predictive models that incorporate multidimensional clinical and imaging data, enhancing both precision and efficiency in diagnosis. These innovations offer promising prospects for building comprehensive, cost‐effective, and patient‐friendly diagnostic tools. As these technologies continue to evolve and become standardized in clinical practice, non‐invasive methods are expected to play an increasingly critical role in the early detection and effective management of PH.