DIAGNOSTIC ACCURACY OF PORTAL VEIN DUPLEX DOPPLER SONOGRAPHY IN ASSESSING LIVER CIRRHOSIS SEVERITY: A CROSS-SECTIONAL STUDY KEEPING LIVER BIOPSY AS REFERENCE STANDARD

Abstract

Objective:
To evaluate the diagnostic efficacy of portal vein Duplex Doppler parameters including portal vein diameter (PVD), portal vein peak systolic velocity (PSV), and portal venous flow orientation in assessing liver cirrhosis severity, using liver biopsy as the reference standard.

Place and Duration of Study: Department of Diagnostic Radiology, Capital Development Authority Hospital, CDA Islamabad, performed over six months following approval of synopsis from CPSP.

Methodology:
In a cross-sectional validation study using non-random consecutive sampling, 120 patients with suspected or confirmed liver disease underwent Doppler sonography and liver biopsy within two weeks. Portal vein diameter (PVD), peak systolic velocity (PSV), and flow direction was assessed. These factors were contrasted with histological grading of cirrhosis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed. Data was analyzed using chi-square tests, logistic regression, and diagnostic performance metrics.

Results:
A PSV ≤15 cm/s showed the best diagnostic performance (sensitivity 85.9%, specificity 81.3%) (p = 0.001). PVD ≥13 mm had 79.5% sensitivity and 76.1% specificity (p = 0.003). Reversed/turbulent flow showed high specificity (89.5%) but lower sensitivity (61.9%) (p =  0.017). Logistic regression did not find a statistically significant association between Doppler parameters and biopsy staging. Portal vein PSV <15 cm/s had an odds ratio of 0.67 (95% CI: 0.32–1.40, p = 0.2868) for predicting advanced liver disease. 

Conclusion:
Portal vein Doppler ultrasound is a helpful, non-invasive tool for cirrhosis assessment but shows limited reliability in disease staging. Combining Duplex Doppler sonography with elastography or blood markers may improve diagnostic accuracy in resource-constrained environments like Pakistan