Background <p>Chronic liver diseases are a major global health burden, with cirrhosis and portal hypertension driving morbidity and mortality. Non-invasive assessment of portal hypertension is critical for risk stratification and clinical decision-making. Spleen stiffness measurement (SSM) has emerged as a novel elastography-based biomarker reflecting the hemodynamic consequences of portal hypertension.</p> Main body <p>This review summarizes current evidence on SSM across major chronic liver disease etiologies, including viral hepatitis, metabolic-associated fatty liver disease, and autoimmune liver diseases. We outline the principles and technical evolution of SSM across elastography platforms, including transient elastography, shear-wave elastography, and magnetic resonance elastography. Emerging data indicate that SSM provides incremental value beyond established non-invasive markers such as liver stiffness measurement and platelet count, particularly in refining risk stratification for clinically significant portal hypertension and high-risk varices. SSM may reduce unnecessary endoscopic screening and improve patient selection for therapeutic interventions. This review is based on a structured literature search of PubMed and Web of Science.</p> Conclusions <p>SSM is a promising non-invasive biomarker with increasing translational relevance in the management of chronic liver diseases. With further standardization and prospective validation, SSM has the potential to support precision risk stratification and guide individualized clinical decision-making.</p>