Role of Color Doppler Ultrasonography in the Assessment of Portal Hypertension: A Cross-Sectional Study

Abstract

Background: Portal hypertension is a major consequence of chronic liver disease and is associated with significant morbidity due to ascites, variceal formation, thrombosis, and other vascular complications. Color Doppler ultrasonography provides a non-invasive method for assessing both morphological changes and hemodynamic alterations in the portal venous system. This study evaluated the spectrum of gray-scale and Doppler findings in portal hypertension and assessed the utility of Doppler parameters in differentiating compensated from decompensated cirrhosis. Methods: This cross-sectional study was conducted over 18 months from June 2024 to November 2025 in 50 patients with clinically suspected portal hypertension. All patients underwent abdominal ultrasonography with color and spectral Doppler assessment. Portal vein diameter, respiratory variation, splenic size, ascites, portal venous flow pattern, vascular thrombosis, portosystemic collaterals, portal vein peak systolic velocity (PSV), and pulsatility index (PI) were evaluated. Doppler and gray-scale findings were compared between compensated and decompensated cirrhosis. Results: The study population comprised 37 males (74%) and 13 females (26%). Cirrhosis was the predominant etiology, accounting for 70% of cases. Portal vein diameter was greater than 13 mm in 60% of patients, while 80% demonstrated less than 20% respiratory variation. Splenomegaly and ascites were present in 78% and 86% of patients, respectively. Hepatopetal portal flow was observed in 74%, hepatofugal flow in 6%, to-and-fro flow in 2%, and absent flow in 18%. Portal vein thrombosis was identified in 28% of patients. Splenorenal collaterals were the most frequent collateral pathway (76%). Mean portal vein PSV and PI were 18.6 ± 5.4 cm/s and 0.42 ± 0.15, respectively. Compared with compensated cirrhosis, decompensated cirrhosis showed significantly lower PSV (16.6 ± 4.5 vs. 22.4 ± 4.2 cm/s, p<0.001) and PI (0.37 ± 0.14 vs. 0.51 ± 0.13, p=0.006), along with greater portal vein diameter (14.2 ± 2.1 vs. 12.8 ± 1.4 mm, p=0.028). Splenomegaly, ascites, and portosystemic collaterals were also significantly more frequent in decompensated patients. Conclusion: Color Doppler ultrasonography provides comprehensive non-invasive assessment of portal hypertension by demonstrating structural abnormalities, altered portal venous hemodynamics, vascular complications, and collateral pathways. Portal vein PSV and PI, together with gray-scale findings, showed significant differences between compensated and decompensated cirrhosis. Combined gray-scale, color Doppler, and spectral Doppler assessment may therefore aid in evaluating disease severity and identifying advanced portal hypertensive changes.

Keywords: Portal hypertension; Color Doppler ultrasonography; Portal vein; Portal venous flow; Cirrhosis