Liver and Spleen Stiffness in Portal Hypertension: Baveno VII Thresholds
Combined Baveno VII Criteria with Spleen Stiffness Measurement (SSM)
According to the WFUMB Guideline/Guidance on Liver Multiparametric Ultrasound (Ferraioli et al., 2024), addition of spleen stiffness measurement (SSM) to liver stiffness measurement (LSM) and platelet count (PLT) reduces the proportion of patients falling into the 'gray zone' of CSPH and improves prediction of CSPH and future risk of liver decompensation.
Threshold Values for Exclusion of CSPH
Two models of combined Baveno VII–SSM criteria are presented. CSPH can be ruled out when more than two of the listed criteria are met.
| Criterion | Dual-cutoff Model | Single-cutoff Model |
|---|---|---|
| LSM | <15 kPa | <15 kPa |
| Platelets (PLT) | >150 × 10⁹/L | >150 × 10⁹/L |
| SSM | <40 kPa | <21 kPa |
For exclusion of CSPH by both models, more than two of the three criteria listed above must be met.
Earlier Recommendations on LSM and Portal Hypertension
According to updated WFUMB recommendations (Ferraioli et al., 2018), liver stiffness measurement by transient elastography (TE) >20 kPa can be used to identify patients likely to have clinically significant portal hypertension (HVPG >10 mmHg) — Recommendation 10 (LoE 2b, GoR B).
Recommendation 11 (LoE 2b, GoR B): LSM by TE <20–25 kPa combined with platelet count >110–150 × 10⁹/mL is useful for excluding varices needing treatment.
It has been noted that changes in LSM do not correlate with changes in HVPG in patients on non-selective beta-blocker therapy (Reiberger et al., 2012). Annual LSM measurement for surveillance of patients with portal hypertension was proposed (de Franchis and Baveno, 2015), but has not yet been validated.
Frequently asked questions
What SSM values allow exclusion of CSPH according to Baveno VII?
In the dual-cutoff model, SSM <40 kPa; in the single-cutoff model, SSM <21 kPa — in combination with LSM <15 kPa and platelets >150 × 10⁹/L (WFUMB, 2024).
How many criteria must be met to exclude CSPH?
More than two of the three criteria (LSM, PLT, SSM) must be met within the selected model (WFUMB, 2024).
What LSM threshold indicates probable CSPH?
LSM by TE >20 kPa can be used to identify patients likely to have CSPH (HVPG >10 mmHg) — Recommendation 10, WFUMB 2018 (LoE 2b, GoR B).
Can LSM be used to monitor beta-blocker therapy?
No: changes in LSM do not correlate with changes in HVPG in patients on non-selective beta-blocker therapy (Reiberger et al., 2012).
Why add SSM to LSM and platelet count?
Addition of SSM reduces the proportion of patients in the 'gray zone' of CSPH and improves prediction of CSPH and future risk of liver decompensation (WFUMB, 2024).