Multiparametric Ultrasound for the Noninvasive Diagnosis of Porto-sinusoidal Vascular Liver Disorder

Inclusion criteria - PSVD group * Histologically confirmed diagnosis of porto-sinusoidal vascular disease (PSVD); * Presence of clinically significant portal hypertension, evidenced by at least one specific sign of portal hypertension (e.g., imaging evidence of collateral circulation or porto-systemic shunts, endoscopic evidence of esophageal or gastric varices, or history of gastrointestinal variceal bleeding); * Age ≥ 18 years; * Ability to understand the study information and provide written informed consent; Inclusion criteria - Cirrhosis group * Diagnosis of liver cirrhosis confirmed by liver histology or, alternatively, by compatible findings on imaging, laboratory tests, and physical examination together with a positive history for at least one known cause of chronic liver disease; * Presence of clinically significant portal hypertension, evidenced by at least one specific sign of portal hypertension (e.g., imaging evidence of collateral circulation or porto-systemic shunts, endoscopic evidence of esophageal or gastric varices, or history of gastrointestinal variceal bleeding); * Age ≥ 18 years; * Ability to understand the study information and provide written informed consent. Exclusion criteria - PSVD group (cases) * Presence of other causes of portal hypertension, including but not limited to: history of bone marrow transplantation, Budd-Chiari syndrome or hepatic venous outflow obstruction, hepatic schistosomiasis, Abernethy malformation, hereditary hemorrhagic telangiectasia, sarcoidosis, congenital hepatic fibrosis, or chronic cholestatic liver diseases; * Presence of portal, spleno-mesenteric, or hepatic vein thrombosis; * Prior hepatic or splenic surgery; * Presence of primary or secondary malignant liver tumors; * Presence of a transjugular intrahepatic portosystemic shunt (TIPS) device; * Congenital anomalies of the liver or biliary tract; * History of heart failure; * Contraindications to administration of SonoVue (sulfur hexafluoride microbubbles), including: prior allergic reaction to the active substance or any excipients, known right-to-left shunts, severe pulmonary hypertension (pulmonary artery pressure \> 90 mmHg), uncontrolled systemic hypertension, or adult respiratory distress syndrome; * Inadequate sonographic visualization of the right hepatic lobe; * Pregnancy. Exclusion criteria - Cirrhosis group * Decompensated cirrhosis or Child-Pugh class C; * Cryptogenic cirrhosis; * Presence of other causes of portal hypertension (same list as for PSVD exclusions: history of bone marrow transplantation, Budd-Chiari syndrome or hepatic venous outflow obstruction, hepatic schistosomiasis, Abernethy malformation, hereditary hemorrhagic telangiectasia, sarcoidosis, congenital hepatic fibrosis, chronic cholestatic diseases); * Presence of portal, spleno-mesenteric, or hepatic vein thrombosis; * Prior hepatic or splenic surgery; * Presence of primary or secondary malignant liver tumors; * Presence of a transjugular intrahepatic portosystemic shunt (TIPS) device; * Congenital anomalies of the liver or biliary tract; * History of heart failure; * Contraindications to administration of SonoVue (sulfur hexafluoride microbubbles), including: prior allergic reaction to the active substance or any excipients, known right-to-left shunts, severe pulmonary hypertension (pulmonary artery pressure \> 90 mmHg), uncontrolled systemic hypertension, or adult respiratory distress syndrome; * Inadequate sonographic visualization of the right hepatic lobe; * Pregnancy.