Advertisement

Emergency Radiology

, Volume 26, Issue 6, pp 647–654 | Cite as

The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma

  • Francesca IacobellisEmail author
  • Mariano Scaglione
  • Antonio Brillantino
  • Maria Giuseppina Scuderi
  • Francesco Giurazza
  • Roberto Grassi
  • Giuseppe Noschese
  • Raffaella Niola
  • Naail Yarub Sulaiman Al Zuhir
  • Luigia Romano
Original Article
  • 65 Downloads

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.

Keywords

CT protocol Blunt trauma Liver trauma Liver pseudoaneurysm Active bleeding 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Due to the retrospective nature of the study, an informed consent was not pursued.

References

  1. 1.
    Taourel P, Vernhet H, Suau A, Granier C, Lopez FM, Aufort S (2007) Vascular emergencies in liver trauma. Eur J Radiol 64(1):73–82CrossRefGoogle Scholar
  2. 2.
    Iacobellis F, Ierardi AM, Mazzei MA, Magenta Biasina A, Carrafiello G, Nicola R, Scaglione M (2016) Dual-phase CT for the assessment of acute vascular injuries in high-energy blunt trauma: the imaging findings and management implications. Br J Radiol 89(1061):20150952CrossRefGoogle Scholar
  3. 3.
    Cirocchi R, Trastulli S, Pressi E, Farinella E, Avenia S, Morales Uribe CH, Botero AM, Barrera LM (2015) Non-operative management versus operative management in high-grade blunt hepatic injury. Cochrane Database Syst Rev (8):CD010989Google Scholar
  4. 4.
    Tugnoli G, Cinquantini F, Coniglio C, Biscardi A, Piccinini A, Gordini G, Di Saverio S (2015) “The best is nothing”: non-operative management of hemodynamically stable grade V liver trauma. J Emerg Trauma Shock 8(4):239–240CrossRefGoogle Scholar
  5. 5.
    Barbier L, Calmels M, Lagadec M, Gauss T, Abback PS, Cauchy F, Ronot M, Soubrane O, Paugam-Burtz C (2018) Can we refine the management of blunt liver trauma? J Visc SurgGoogle Scholar
  6. 6.
    Brillantino A, Iacobellis F, Festa P, Mottola A, Acampora C, Corvino F, Del Giudice S, Lanza M, Armellino M, Niola R, Romano L, Castriconi M, De Palma M, Noschese G (2019) Non-operative management of blunt liver trauma: safety, efficacy and complications of a standardized treatment protocol. Bull Emerg Trauma 7(1):49–54CrossRefGoogle Scholar
  7. 7.
    Graves JA, Hanna TN, Herr KD (2017) Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know. Emerg Radiol 24(5):557–568CrossRefGoogle Scholar
  8. 8.
    Boscak AR, Shanmuganathan K, Mirvis SE, Fleiter TR, Miller LA, Sliker C, Steenburg SD, Alexander M (2013) Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 268(1):79–88CrossRefGoogle Scholar
  9. 9.
    Melikian R, Goldberg S, Strife BJ, Halvorsen RA (2016) Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging. Diagn Interv Radiol 22(5):355–359CrossRefGoogle Scholar
  10. 10.
    Uyeda JW, LeBedis CA, Penn DR, Soto JA, Anderson SW (2014) Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT. Radiology 270(1):99–106CrossRefGoogle Scholar
  11. 11.
    Schueller G, Scaglione M, Linsenmaier U, Schueller-Weidekamm C, Andreoli C, De Vargas Macciucca M, Gualdi G (2015) The key role of the radiologist in the management of polytrauma patients: indications for MDCT imaging in emergency radiology. Radiol Med 120(7):641–654CrossRefGoogle Scholar
  12. 12.
    Soto JA, Anderson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology. 265(3):678–693CrossRefGoogle Scholar
  13. 13.
    Beenen LF, Sierink JC, Kolkman S, Nio CY, Saltzherr TP, Dijkgraaf MG, Goslings JC (2014) Split bolus technique in polytrauma: a prospective study on scan protocols for trauma analysis. Acta Radiol 56(7):873–809CrossRefGoogle Scholar
  14. 14.
    Eichler K, Marzi I, Wyen H, Zangos S, Mack MG, Vogl TJ (2015) Multidetector computed tomography (MDCT): simple CT protocol for trauma patient. Clin Imaging 39(1):110–115CrossRefGoogle Scholar
  15. 15.
    Loupatatzis C, Schindera S, Gralla J, Hoppe H, Bittner J, Schröder R, Srivastav S, Bonel HM (2008) Whole-body computed tomography for multiple traumas using a triphasic injection protocol. Eur Radiol 18(6):1206–1214CrossRefGoogle Scholar
  16. 16.
    Nguyen D, Platon A, Shanmuganathan K, Mirvis SE, Becker CD, Poletti PA (2009) Evaluation of a single-pass continuous wholebody, 16-MDCT protocol for patients with polytrauma. Am J Roentgenol 192(1):3–10CrossRefGoogle Scholar
  17. 17.
    Yaniv G, Portnoy O, Simon D, Bader S, Konen E, Guranda L (2013) Revised protocol for whole-body CT for multi-trauma patients applying triphasic injection followed by a single-pass scan on a 64-MDCT. Clin Radiol 68(7):668–675CrossRefGoogle Scholar
  18. 18.
    Leung V, Jones H, Sastry A (2014) Can split bolus CT protocols prevent excess radiation dose in trauma CT? Clin Radiol 69:S23CrossRefGoogle Scholar
  19. 19.
    Scaglione M, Iaselli F, Sica G, Feragalli B, Nicola R (2015) Errors in imaging of traumatic injuries. Abdom Imaging 40(7):2091–2098CrossRefGoogle Scholar
  20. 20.
    Sica G, Guida F, Bocchini G, Codella U, Mainenti PP, Tanga M, Scaglione M (2012) Errors in imaging assessment of polytrauma patients. Semin Ultrasound CT MR 33(4):337–346CrossRefGoogle Scholar
  21. 21.
    Uyeda JW, Anderson SW, Sakai O, Soto JA (2010) CT angiography in trauma. Radiol Clin N Am 48(2):423–438 ix-xCrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2019

Authors and Affiliations

  • Francesca Iacobellis
    • 1
    • 2
    Email author
  • 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
  1. 1.Department of General and Emergency Radiology“A. Cardarelli” HospitalNaplesItaly
  2. 2.Department of RadiologyUniversity of Campania “L. Vanvitelli”NaplesItaly
  3. 3.Department of RadiologySunderland Royal Hospital, NHSSunderlandUK
  4. 4.Department of RadiologyPineta Grande HospitalCastel VolturnoItaly
  5. 5.Trauma Center“A. Cardarelli” HospitalNaplesItaly
  6. 6.Interventional Radiology Department“A. Cardarelli” HospitalNaplesItaly

Personalised recommendations