Assessing the main portal vein is routine in abdominal ultrasound, but a deeper grasp of Doppler principles and portal venous anatomy allows us to extract far richer diagnostic insight. This session explores how subtle Doppler clues can reveal normal and abnormal venous and arterial patterns in patients with portal hypertension. We’ll also revisit the anatomy of the portal and systemic venous systems to understand how collateral pathways develop—and how recognising them can elevate the clinical value of our studies. By expanding our Doppler toolkit, we can provide more meaningful information to referrers and ultimately enhance patient care.

With the rising global burden of metabolic dysfunction-associated steatotic liver disease (MASLD), accurate assessment of hepatic steatosis is increasingly important for detection, guiding clinical management, and monitoring therapeutic response. Ultrasound plays a central role in this pathway. However, traditional B-mode grading is inherently subjective, and quantitative approaches, while increasingly available, require optimisation, standardisation, and informed interpretation.

This session will briefly review key B-mode considerations before focusing on the optimisation and interpretation of emerging quantitative techniques. Attenuation-based, backscatter and combined methods will be addressed, with an emphasis on technique, reproducibility and common pitfalls. Vendor-specific outputs will be discussed in the context of current consensus recommendations, alongside practical strategies to improve consistency and confidence in everyday clinical practice.