Liver Stiffness Measurements in Patients with Noncirrhotic Portal Hypertension—The Devil Is in the Details

Noncirrhotic portal hypertension (NCPH) is often a diagnostic challenge due to signs and symptoms of portal hypertension that overlap with cirrhosis. The etiology of NCPH is broadly classified as prehepatic, hepatic (presinusoidal and sinusoidal) and posthepatic.1 Some common etiologies of NCPH encountered in clinical practice include portal vein thrombosis (prehepatic) and nodular regenerative hyperplasia (hepatic). Liver histology, although considered gold standard to exclude cirrhosis in individuals with suspected NCPH, is often limited by subtle histologic features or inadequate sampling. Liver stiffness measurements (LSMs) by vibration‐controlled transient elastography may provide clinically important information to distinguish NCPH from cirrhosis by revealing normal LSM in prehepatic and presinusoidal NCPH.