OBJECTIVE To determine if portal vein thrombosis (PVT) is associated with changes in the hepatic artery resistive index (RI) at Doppler ultrasonography (US). METHODS In 35 patients with findings suspicious for PVT, prospective hepatic artery RIs were obtained before angiographic proof of portal vein status. RIs were also obtained from 27 age-matched patients with liver disease (without PVT) and from eight patients with PVT (without occlusion). RESULTS Twenty-seven of the 35 patients had proved PVT and a significantly lower (P < .01) mean hepatic artery RI than did patients in any other group studied. Twelve of these 27 patients had RI values of .50 or less, while none of the patients in any other group studied had an RI value this low (specificity, 100%). CONCLUSIONS A reduction in hepatic artery RI accompanies PVT and may be a helpful secondary sign to determine this venous abnormality.