Non-invasive differentiation of porto-sinusoidal vascular disease and cirrhosis: The Devil is in the details!

We read with great interest the article by Elkrief L et al.(1) titled "Liver stiffness by transient elastography to detect porto-sinusoidal vascular liver disease (PSVD) with portal hypertension". The authors have included a large number of patients of this relatively infrequent disease and have tried to address the important clinical problem of differentiating PSVD from compensated cirrhosis, non-invasively. Most often, PSVD patients are mis-labelled or diagnosed late due to difficulties in making a confident diagnosis without liver biopsy.(2).