Background: As commonest form among liver diseases, nonalcoholic fatty liver disease (NAFLD) presents no symptoms. It is possible to use regular ultrasound scanning, which are always available in medical care centers everywhere, to quickly and quantitatively assess portal vein pulsatility. Objective: To evaluate the value of the portal venous pulsatility index for noninvasively diagnosing nonalcoholic fatty liver disease who are at high risk. Patients and Methods: The trial was a comparative cross-sectional trial involving 145 NAFLD patients, conducted in Radiodiagnosis Department, Faculty of Medicine, Zagazig University Hospitals. Abdominal ultrasound fibroscan, and Doppler US examinations of portal venous system were done to all patients. Results: Basal lab features, triphasic right hepatic vein flow pattern, and Doppler flow characteristics differed significantly between the two groups. Except for the BARD score, there was a high statistically significant difference between the two groups for venous pulsatility index values as well as all clinical risk scores. VPI, NAFLD-FS, and FIB-4 odds ratios all showed high significant differences between the two groups. Optimism-Corrected ROC AUC of VPI +NAFLD FS was 0.89, VPI + FIB-4 was 0.90, VPI+BARD score was 0.86 and VPI + APRI was 0.85. There was a high significant difference regarding VPI +NAFLD FS & VPI + FIB-4.