Portal Vein and Hepatic Artery Doppler Indices in Non-Alcoholic Fatty Liver Disease: Relationship with Ultrasonographic Steatosis Grading.

Background: Non-alcoholic fatty liver disease is commonly detected and graded by grayscale ultrasonography; however, conventional ultrasound provides limited information about hepatic hemodynamic changes. Doppler ultrasonography may add functional assessment through evaluation of portal venous and hepatic arterial flow parameters. Objective: To assess portal vein and hepatic artery Doppler indices in patients with fatty liver disease and evaluate their relationship with ultrasonographic steatosis grade. Patients and Methods: This cross-sectional case-control study included 60 adult participants divided into four equal groups: 15 healthy controls, 15 patients with Grade I fatty liver, 15 with Grade II, and 15 with Grade III. All participants underwent grayscale abdominal ultrasonography and Doppler assessment. Portal vein maximum velocity, minimum velocity, mean flow velocity, and pulsatility index were measured. Hepatic artery peak systolic velocity, end-diastolic velocity, and resistive index were also recorded. Doppler indices were compared across fatty liver grades, with correlation and ROC curve analyses performed. Results: Portal vein maximum, minimum, and mean flow velocities decreased progressively with increasing fatty liver grade, while portal vein pulsatility index increased significantly. Hepatic artery peak systolic velocity and resistive index increased with higher grades, whereas end-diastolic velocity decreased. Hepatic artery resistive index and portal vein pulsatility index showed the highest diagnostic performance. Conclusion: Doppler ultrasonography provides useful functional information complementary to grayscale ultrasound grading in fatty liver disease.