RadteraLiver Doppler Ultrasound
USNo contrastAbdomen & Pelvis
Indications
- Portal hypertension / cirrhosis
- Suspected portal vein thrombosis
- Suspected Budd-Chiari syndrome
- TIPS surveillance
- Pre/post liver transplant vascular assessment
- Evaluation of hepatic vasculature
Patient prep
- NPO 6-8 hours to reduce bowel gas and standardize portal flow
- Supine; quiet breathing/breath-hold for Doppler windows
Contrast
None / non-contrast
Technique
- Curvilinear 2-5 MHz transducer
- Grayscale survey of liver parenchyma
- Color and spectral Doppler of portal, hepatic, and hepatic arterial systems with low wall filter and appropriate scale
- Doppler angle <=60 degrees; report flow direction and waveform
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Liver parenchyma survey | Long and transverse | Echotexture, nodularity, masses |
| 2 | Main portal vein | Spectral + color | Flow direction (hepatopetal vs hepatofugal), velocity, patency, thrombus |
| 3 | Right and left portal branches | Color/spectral | Patency/direction |
| 4 | Hepatic artery | Spectral | Waveform; resistive index |
| 5 | Hepatic veins (right/middle/left) | Spectral | Phasicity (triphasic normal); patency for Budd-Chiari |
| 6 | IVC | Spectral/color | Patency |
| 7 | TIPS shunt (if present) | Spectral | Velocities within stent and main portal vein for surveillance |
| 8 | Splenic/portal confluence; spleen | As needed | Splenomegaly, collaterals/varices, ascites |
Key points
- Document portal vein direction and velocity; hepatofugal flow indicates portal hypertension
- Hepatic veins normally show triphasic flow; loss/monophasic suggests parenchymal disease or Budd-Chiari (absent flow)
- Set low wall filter and appropriate PRF for slow venous flow; angle <=60 degrees
- For TIPS, record stent and portal velocities and compare to baseline; look for stenosis/occlusion
References
• AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen (with Doppler)
• ACR Appropriateness Criteria: Liver Lesion / Portal Hypertension
• Radiopaedia: Liver Doppler / portal hypertension link
• ACR Appropriateness Criteria: Liver Lesion / Portal Hypertension
• Radiopaedia: Liver Doppler / portal hypertension link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.