Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment.

Methods This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10).

Results In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m² [20.4–23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36–0.87), recording a median blood flow of 834 ml/min (624–1066) and 718 ml/min (620–811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55–72); BMI 27.8 kg/m² (25.4–30.8)), but the correlation between PFA and PW-Doppler was poor (r=− 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis.

Conclusion PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.