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Hepatic Doppler Perfusion Index in Healthy Adults: Standardization, Physiological Reference Limit, and Clinical
Christian Lueders1,2,3, Johannes Gladitz4, Nils Eckstein1
1Klinik am See, Rehabilitation Center for Internal Medicine, Seebad 84, 15562 Rüdersdorf bei Berlin, Germany.
Diagnostics (Basel, Switzerland)
|June 26, 2026
Summary
The Doppler perfusion index (DPI) can be standardized for clinical use. A DPI of approximately 0.30, measured under fasting conditions using the proper hepatic artery, is proposed as an upper physiological reference limit.
Area of Science:
- Hepatology
- Medical Imaging
- Hemodynamics
Background:
- The Doppler perfusion index (DPI) assesses hepatic hemodynamic balance by measuring arterial to total hepatic blood flow.
- Clinical use of DPI is hindered by a lack of standardization and defined physiological reference conditions.
- Establishing a reliable upper physiological limit for DPI is crucial for its clinical applicability.
Purpose of the Study:
- To establish an upper physiological reference limit for the DPI in healthy adults.
- To evaluate the DPI's dependence on standardized physiological conditions.
- To provide a basis for reproducible DPI measurements in clinical settings.
Main Methods:
- Prospective study involving 44 healthy adults undergoing Doppler ultrasonography.
- Standardized conditions included fasting/resting, post-exercise, and postprandial states.
- Volumetric blood flow measured in the portal vein and hepatic arteries; DPI calculated as arterial/total hepatic inflow.
Main Results:
- Analysis of 39 participants revealed DPI variability across different physiological states.
- Under fasting/resting conditions, DPI using the proper hepatic artery showed low variability (mean 0.242 ± 0.057).
- An empirically derived 90th percentile of 0.30 was established as a potential upper physiological reference limit.
Conclusions:
- The DPI is a dynamic parameter requiring standardized measurement conditions for clinical utility.
- A DPI of approximately 0.30, measured under standardized fasting conditions via the proper hepatic artery, can serve as an upper physiological reference limit.
- Standardized methodology enhances reproducibility and interpretability, supporting future clinical applications, particularly in oncology.
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