PURPOSE: This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of Doppler ultrasound indices specifically the hepatic vein resistive index (HVRI) and hepatic artery resistive index (HARI) for detecting significant liver fibrosis (≥ F2), using liver biopsy as the reference standard. The key research question was whether HVRI and HARI can reliably detect significant fibrosis in chronic liver disease. METHODS: A comprehensive search was conducted across PubMed, Web of Science, Cochrane Library, and Scopus. Eligible studies assessed HVRI or HARI against biopsy-confirmed fibrosis grades. Pooled sensitivity and specificity were calculated using a random-effects model to account for inter-study heterogeneity. Four studies met the inclusion criteria. RESULTS: HVRI demonstrated high diagnostic accuracy, with pooled sensitivity of 91% (95% CI, 0.75-0.97; I2 = 69%) and specificity of 89% (95% CI, 0.84-0.93; I2 = 11%). In contrast, HARI showed lower sensitivity of 65% (95% CI, 0.44-0.81; I2 = 82%) and specificity of 60% (95% CI, 0.42-0.76; I2 = 81.2%). ROC curve analysis confirmed the superior performance of HVRI over HARI. CONCLUSION: HVRI shows high diagnostic accuracy for significant liver fibrosis in the research context but its translation to routine clinical use is inhibited by high heterogeneity, operator dependency and reproducibility. Further validation in diverse and low-resource populations with standardized protocols is essential to establish its clinical utility and expand accessibility.