Spleen Stiffness Measurement in Metabolic Dysfunction-Associated Steatotic Liver Disease—Value Added or Work in Progress?

Excerpt

Metabolic dysfunction-associated steatotic liver disease (MASLD), defined as hepatic steatosis associated with the metabolic syndrome, is of increasing global prevalence and importance due to its many consequent morbidities. MASLD is characterized by several clinical milestones that predict prognosis. Compared with patients with none—mild liver fibrosis (F0-2), those with advanced fibrosis (\(\ge\) F3) or cirrhosis (F4) have a progressively higher risk of liver-related complications [1]. Once cirrhosis develops, the presence of clinically significant portal hypertension [CSPH; i.e., hepatic portal venous gradient (HVPG) \(\ge\) 10 mmHg] is associated with morbid complications such as esophageal varices, variceal bleeding, and ascites [2]. Thus, determining the disease stage has important implications for management, including informing decisions on when to initiate liver-directed pharmacotherapy (based on liver fibrosis stage), initiate hepatocellular carcinoma surveillance (based on the development of cirrhosis), and performing variceal screening (based on development of portal hypertension) [3]. …