PurposeThe mechanisms underlying the morphological changes in liver cirrhosis remain unknown. This study aimed to clarify the relationship between fibrotic hepatic morphology and portal hemodynamic changes using four-dimensional flow magnetic resonance imaging (MRI).Materials and methodsOverall, 100 patients with suspected liver disease who underwent 3-T MRI were evaluated in this retrospective study. Liver fibrosis was assessed using a combination of visual assessment of the hepatic morphology and quantitative measures, including the fibrosis-4 index and aspartate transaminase-to-platelet ratio. It was classified into three groups according to the severity of fibrosis as follows: A (normal), B (mild-to-moderate), and C (severe). Quantitative indices, including area (mm2), net flow (mL/s), and average velocity (cm/s), were measured in the right portal vein (RPV) and left portal vein (LPV), and were compared across the groups using the Kruskal–Wallis and Mann–WhitneyUtests.ResultsAmong the 100 patients (69.1 ± 12.1 years; 59 men), 45, 35, and 20 were categorized into groups A, B, and C, respectively. The RPV area significantly differed among the groups (fromp< 0.001 top= 0.001), showing a gradual decrease with fibrosis progression. Moreover, the net flow significantly differed between groups A and B and between groups A and C (p< 0.001 andp< 0.001, respectively), showing a decrease during the early stage of fibrosis. In the LPV, the net flow significantly differed among the groups (fromp= 0.001 top= 0.030), revealing a gradual increase with fibrosis progression.ConclusionThe atrophy–hypertrophy complex, which is a characteristic imaging finding in advanced cirrhosis, was closely associated with decreased RPV flow in the early stage of fibrosis and a gradual increase in LPV flow across all stages of fibrosis progression.