ORIGINAL ARTICLE The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma Francesca Iacobellis 1,2 & Mariano Scaglione 3,4 & Antonio Brillantino 5 & Maria Giuseppina Scuderi 1 & Francesco Giurazza 6 & Roberto Grassi 2 & Giuseppe Noschese 5 & Raffaella Niola 6 & Naail Yarub Sulaiman Al Zuhir 3 & Luigia Romano 1 Received: 20 June 2019 /Accepted: 2 August 2019 # American Society of Emergency Radiology 2019 Abstract Purpose In the literature, no consensus exists about which CT protocol is to be adopted in patients who underwent high-energy blunt trauma. The aim of the study is to evaluate the additional value of the arterial phase in the CT assessment of vascular injuries of the liver. Methods Admission CT examinations for patients with traumatic injury of the liver due to high-energy blunt trauma, performed between 2011 and 2017 in two major trauma centres, were retrospectively reviewed. Images were analysed for presence or absence of liver parenchymal injury, intrahepatic contained vascular injuries and active bleeding in the arterial and portal venous phase of the CT study. Results Two hundred twelve patients have been identified. Parenchymal injuries were detected as isolated in 90.6% of cases, whereas they were associated with vascular injuries in 9.4% of cases: contained vascular injuries in 3.3% and active bleeding in 6.1%. Out of all parenchymal injuries detected on the CT portal venous phase, 90.5% were also detectable in the arterial phases (p < 0.0001). All of the contained vascular injuries were visible in the CT arterial phase, whereas they were detectable in 28.5% of cases also during the venous phase (p = 0.02). All 13 cases of active bleeding were detected on the CT venous phase, and 76.9% of these cases were also revealed in the arterial phase, thus confirming their arterial origin (p = 0.22). Conclusion The addiction of the arterial phase to the venous phase in the CT assessment of patients who underwent high-energy blunt trauma allows an accurate identification and characterization of traumatic vascular injuries, so distinguishing between patients suitable for conservative management and those requiring interventional or surgical treatment. Francesca Iacobellis and Mariano Scaglione contributed equally to this work. * Francesca Iacobellis iacobellisf@gmail.com Mariano Scaglione scaglionefun@gmail.com Antonio Brillantino antonio.brillantino@gmail.com Maria Giuseppina Scuderi margiscuderi@hotmail.com Francesco Giurazza francescogiurazza@hotmail.it Roberto Grassi roberto.grassi@unicampania.it Giuseppe Noschese giuseppenoschese@gmail.com Raffaella Niola raffaellaniola@tiscali.it Naail Yarub Sulaiman Al Zuhir naail.alzuhir@nhs.net Luigia Romano luigia.romano1@yahoo.com 1 Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli, 9, 80131 Naples, Italy 2 Department of Radiology, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy 3 Department of Radiology, Sunderland Royal Hospital, NHS, Kayll Road, Sunderland SR4 7TP, UK 4 Department of Radiology, Pineta Grande Hospital, Via Domiziana Km 30,00, Castel Volturno, CE, Italy 5 Trauma Center, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy 6 Interventional Radiology Department, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy Emergency Radiology https://doi.org/10.1007/s10140-019-01714-y