Four-dimensional flow MRI is a potential non-invasive tool for diagnosing clinically significant portal hypertension

Portal hypertension (PH) is the primary cause of severe complications associated with cirrhosis, such as hepatic encephalopathy, ascites, and gastroesophageal variceal bleeding. Measurement of hepatic venous pressure gradient (HVPG) derived by subtracting the free hepatic venous pressure from the wedged hepatic venous pressure via catheterization of the right hepatic vein stands as a well-established technique for assessing portal venous pressure 1 . An HVPG equal to or exceeding 10 mm Hg denotes clinically significant portal hypertension (CSPH), serving as a pivotal parameter for prognostication and treatment response evaluation among patients with portal hypertension 2 , 3 , 4 . But it is limited due to invasive examination, cost implications, perceived risks, and limited availability. Currently, several noninvasive techniques such as transient ultrasound elastography and two-dimensional phase-contrast MRI are available noninvasive imaging method for detecting CSPH, but the results are still unsatisfactory 5 , 6 , 7 . Thus, it is urgent to explore a new alternative noninvasive method for CSPH diagnosis.