Liver Stiffness by Transient Elastography to Detect Porto‐Sinusoidal Vascular Liver Disease With Portal Hypertension

Background and Aims Porto‐sinusoidal vascular liver disease (PSVD) is a rare cause of portal hypertension. PSVD is still often misdiagnosed as cirrhosis, emphasizing the need to improve PSVD diagnosis strategies. Data on liver stiffness measurement using transient elastography (TE‐LSM) in PSVD are limited. The aim of this study was to evaluate the accuracy of TE‐LSM to discriminate PSVD from cirrhosis in patients with signs of portal hypertension. Approach and Results Retrospective multicenter study comparing TE‐LSM in patients with PSVD, according to Vascular Liver Disease Interest Group criteria, with patients with compensated biopsy‐proven cirrhosis associated with alcohol (n = 117), HCV infection (n = 110), or NAFLD (n = 46). All patients had at least one sign of portal hypertension among gastroesophageal varices, splenomegaly, portosystemic collaterals, history of ascites, or platelet count < 150 × 109/L. The 77 patients with PSVD included in the test cohort had lower median TE‐LSM (7.9 kPa) than the patients with alcohol‐associated, HCV‐related, and NAFLD‐related cirrhosis (33.8, 18.2, and 33.6 kPa, respectively; P