 Hello everyone, I am Dr. Parth Doshi, second year PG resident in the department of radio diagnosis at SDKS Medical Institute and Research Center, Vadodra. The title for my paper is evaluation of portal hypertension using color Doppler ultrasound. Portal hypertension is characterized by an increase of pressure gradient between the portal vein and the inferior vena cava, above 5 millimeter of mercury and develops when there is a resistance in the portal vena system exacerbated by an increase splansionic and portal collateral blood flow. Liver cirrhosis represents the most common cause of portal hypertension in general, but we can broadly classify the ideologies of portal hypertension under three heads as follows as described pre-hypatic, intrahepatic and post-hypatic. Portal hypertension imaging ultrasound techniques such as color Doppler imaging or power Doppler imaging are the modalities of choice because they are non-invasive, rapid, highly sensitive and specific. The aim and objectives of this study is to assess the role of color Doppler in cases of portal hypertension over grayscale ultrasound and to analyze the spectrum of imaging findings on grayscale ultrasound in cases of portal hypertension. A checklist of parameters that need to be assessed for all the patients recruited in the study was prepared beforehand and primarily included the following pointers. Portal vein diameter which normally increases during inspiration, portal flow velocity and waveforms normally which is around 15 to 20 centimeters per second. Portal flow direction which normally shows hepatopetal flow but due to increased resistance to the flow as in cases of liver cirrhosis the portal blood flow decreases and collateral circulation pathways are established as a compensatory measure which leads to flow pattern changes into a bifasic one that is two and flow pattern. Portal and splenic vein flow, variation of portal and splenic flow pattern with changes in respiration, lean size, formation of collaterals that is photosystemic and astromosis and hepatic vein damping index HVDI. A total of 57 patients were included in this study who came to the radiology department from the period of June 2023 to August 2023. Every patient was subjected to an ultrasound examination using gene-logic P9 machine, the inclusion criteria being cases with clinical suspicion of portal hypertension, cases of alcohol or chronic liver diseases and patients with altered liver laboratory parameters, exclusion criteria being ecodynamically unstable patients and the patients not willing to give their consent. Results and analysis of this study are as follows, almost 82 percent it was observed that almost 82 percent of the patients had epatomegaly that is more than 15 centimeters in craniocautal dimension and 67 percent of the patients showed coarse and heterogeneous ecotexture while almost 47 percent of the patients had an enlarged portal vein diameter more than 13 mm. Hepatic vein damping index less than 0.6 was observed in almost 81 percent of the cases. 74 percent of the patients showed a sprenomegaly spleen size more than 12 centimeter. 65 percent of the patients had enlarged and dilated sprenic vein work at off taken as 10 mm. However, the sprenic vein flow pattern in majority of the cases that is 88 percent of the cases was normal hepato-petal flow. Only one patient had hepato-fugal flow in sprenic vein. Periportal collaterals were seen in almost 47 percent of the cases while the second most common was peri sprenic collaterals while we also observed peripancreatic and paramedical collaterals. 67 percent of the cases had a sinus along with portal hypertension and coming to portal vein flow pattern, 86 percent of the patients had normal hepato-petal flow while two patients had hepato-fugal flow and only one patient had bifasic flow that is two and flow pattern. These are certain ultrasound images showing the normal anatomy at porta, certain peripancreatic collaterals, cabanometals transformation of the portal vein due to multiple collaterals and a normal portal venous flow with its waveform. These images show the centrifugal flow pattern in the portal vein along with a cytus and a dilated portal vein, a bisphysic waveform noticed in portal vein which is two and flow pattern and normal triphysic waveform of the hepatic vein. Doppler ultrasonography is a non-invasive method of evaluating hepatic and portal hemodynamics. The change of waveform in hepatic vein as seen by Doppler ultrasonography could be an invaluable tool in assessing portal hypertension in cirrhotic patients. Hepatic vein waveform in a healthy person is normally triphysic that is two negative waves and a positive wave due to cardiac variations in the CBP. Normal triphysic hepatic vein Doppler waveform is transformed into a bifasic or monophasic waveform in cirrhosis and portal hypertension. The hepatic vein damping index is a quantitative parameter to assess the extent of the abnormal waveform. In this study out of 57 patients examined, 51 were males and 6 were females. Majority of the patients lying in age group of 45 to 55 years which is almost around 36 patients. Liver disease demonstrates a sex predilection with males making up for more than 60% of the patients with chronic liver disease and cirrhosis. However, higher incidence among males could be attributed to the alcohol consumption leading to cirrhosis and portal hypertension. Gibson et al. found that sprenomegalli is a specific sign of portal hypertension. In this study, 74% of the patients also had sprenomegalli with screen size more than 12 centimetre. Ditchfield et al. reported 59% of the patients with screen size of more than 13 centimetres. A study by Boulogne et al. suggested that portal vein diameter more than 13 mm is a fairly characteristic sign of portal hypertension. The same was observed in our study as well with almost 47% of the patients having portal vein diameter more than 13 mm. Another study by Doc Macy et al. in which they assessed 38 patients for diagnostic value of real-time ultrasound for portal hypertension. In comparison with percutaneous trans-hepatic photography showed that frequency of detection of collactals by ultrasonography was 85% for coronary, 100% for parabolical and 10% for short gastric vein. Here also it was concluded that sonography is the first choice of investigation for demonstrating collateral veins and diagnosing portal hypertension. The damping index of the hepatic vein waveform obtained via Doppler might be a non-invasive supplementary tool in evaluation of severity of portal hypertension in patients with liver cirrhosis. Coming to conclusion, Doppler sonography is a valuable in non-invasive alternative which not only provides precise information in localizing and characterizing the portal vein among the patients with portal hypertension but is also helpful in identifying the presence of various photosystemic collaterals. The hepatic vein damping index correlates well with the severity of liver dysfunction in cases of liver cirrhosis. So these are my references. Thank you.