Diagnostic Accuracy of Portal Vein Doppler Ultrasound in the Non-Invasive Assessment of Patients with Chronic Liver Disease

Abstract

Background: Chronic liver disease (CLD) is a progressive condition characterized by hepatic inflammation, fibrosis, and architectural distortion that culminates in cirrhosis and portal hypertension. While liver biopsy remains the diagnostic gold standard, its invasiveness, cost, and procedural risks limit feasibility in many clinical settings. Doppler ultrasonography offers a non-invasive, physiologically grounded method to assess portal hemodynamics, yet its diagnostic accuracy compared with histopathology in CLD remains variably reported. Objective: To determine the diagnostic accuracy of portal vein Doppler ultrasonography in assessing chronic liver disease, using histopathological findings as the gold standard. Methods: This cross-sectional study was conducted in the Department of Diagnostic Radiology, Bolan Medical College and Hospital, Quetta, from January to July 2025. A total of 200 patients aged 18–70 years with clinically suspected CLD underwent standardized portal vein Doppler ultrasonography followed by ultrasound-guided liver biopsy. Key Doppler parameters included portal vein diameter, velocity, flow direction, collateral presence, hepatic venous waveform, and hepatic artery resistive index. Histopathological confirmation was based on METAVIR staging. Diagnostic performance metrics—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and accuracy—were computed using histopathology as the gold standard. Results: Doppler ultrasound demonstrated a sensitivity of 94.4% (95% CI: 89.0–98.0) and specificity of 78.5% (95% CI: 68.0–87.0), with a PPV of 91.2%, NPV of 78.5%, and overall diagnostic accuracy of 90%. Diagnostic performance was higher in older patients and females. Combined reduction in portal vein velocity (<16 cm/s) and elevated hepatic artery resistive index (>0.80) strongly predicted histopathologically confirmed CLD. Conclusion: Portal vein Doppler ultrasonography exhibits high diagnostic accuracy and clinical utility as a non-invasive alternative to biopsy for evaluating chronic liver disease. It enables early identification of hemodynamic alterations and supports its integration into routine CLD assessment, particularly in resource-limited healthcare settings.