Percutaneous Portal Venography vs. Contrast-Enhanced CT in Pediatric Extrahepatic Portal Vein Obstruction: A Comparative Study

Background Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension in children. Imaging is essential for diagnosis and treatment planning. While CT is commonly used, it may miss patent intrahepatic branches. Percutaneous portal venography (PVG) offers more detailed vascular imaging but is invasive. Comparative studies between CT and PVG in pediatric EHPVO are limited Objectives To compare the effectiveness of contrast-enhanced computed tomography (CT) and percutaneous portal venography (PVG) in visualizing intrahepatic portal vein segments and various findings such as varices, shunts, and portal biliopathy in children with non-cirrhotic, non-malignant, chronic extrahepatic portal vein obstruction (EHPVO). Materials & Methods This retrospective single-center study included pediatric patients with EHPVO between 2018 and 2024. All patients underwent contrast-enhanced CT and PVG before attempted portal vein recanalization. Imaging findings were compared for intrahepatic portal vein visualization, cavernoma type, presence of varices and shunts, and portal biliopathy. Statistical analysis included McNemar's test, chi-square/Fisher’s exact test, and one-way ANOVA. Results This study included 18 pediatric patients (mean age, 7.0 ± 2.8 years; 12 males). PVG demonstrated significantly higher visualization rates of intrahepatic portal vein branches in segments 4–8 (p = 0.013–0.035) compared to CT. CT failed to identify some branches that were patent on PVG. Cavernoma type showed no significant association with patient age or presence of portal biliopathy (p > 0.05). Gallbladder and gastric varices were strongly associated and inversely related to splenorenal shunts (p = 0.029). Conclusion CT and PVG are complementary tools in the management of pediatric EHPVO. While CT supports pre-procedural planning, PVG provides superior intrahepatic vascular detail and facilitates recanalization. However, the lack of predictive criteria for procedural success highlights the need for further research in patient selection.