Luca Maria Sconfienza1,2, Domenico Albano3, Georgina Allen4, Alberto Bazzocchi5, Bianca Bignotti6, Vito Chianca7, Fernando Facal de Castro8, Elena E Drakonaki9, Elena Gallardo10, Jan Gielen11, Andrea Sabine Klauser12, Carlo Martinoli6,13, Giovanni Mauri14, Eugene McNally15, Carmelo Messina16,17, Rebeca Mirón Mombiela8,18, Davide Orlandi19, Athena Plagou20, Magdalena Posadzy21, Rosa de la Puente22, Monique Reijnierse23, Federica Rossi6, Saulius Rutkauskas24, Ziga Snoj25, Jelena Vucetic8,18, David Wilson4, Alberto Stefano Tagliafico6,13. 1. Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy. io@lucasconfienza.it. 2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy. io@lucasconfienza.it. 3. Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy. 4. Department of Radiology, St Lukes Radiology Oxford Ltd, Oxford, UK. 5. Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Bologna, Italy. 6. Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132, Genova, Italy. 7. Department of Advanced Biomedical Sciences, Università degli studi Federico II, via Pansini 5, 80131, Napoli, Italy. 8. Hospital General Universitario de Valencia, Ave. Tres Cruces 2, 46014, Valencia, Spain. 9. Independent MSK radiology practice, Heraklion, Crete, Greece. 10. Department of Radiology, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain. 11. Radiology and S.P.O.R.T.S. Department, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium. 12. Department of Radiology, Medical University Innsbruck, Section Rheumatology and Sports Imaging, Innsbruck, Austria. 13. Ospedale Policlinico San Martino, Genova, Italy. 14. Division of Interventional Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milano, Italy. 15. Oxford Musculoskeletal Radiology, Oxford, UK. 16. Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy. 17. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy. 18. Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain. 19. S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale, Corso Solferino 1A, 16122, Genova, Italy. 20. Department of Radiology, Private Institution of Ultrasonography, Athens, Greece. 21. Department of Radiology, W. Dega Orthopaedic and Rehabilitation University Hospital of Karol Marcinkowski University of Medical Sciences, Poznan, Poland. 22. Hospital Universitario Marqués de Valdecilla, Santander, Spain. 23. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 24. Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania. 25. Ljubljana University Medical Centre, Clinical Institute of Radiology, Ljubljana, Slovenia.
Abstract
OBJECTIVES: To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe. METHODS: Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%. RESULTS: A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication. CONCLUSIONS: Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate. KEY POINTS: • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications. • Four new A evidence levels were found for the hip, knee, ankle, and foot. • There was no level A evidence for elastography.
OBJECTIVES: To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe. METHODS: Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%. RESULTS: A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication. CONCLUSIONS: Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate. KEY POINTS: • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications. • Four new A evidence levels were found for the hip, knee, ankle, and foot. • There was no level A evidence for elastography.
Authors: Melissa C Brouwers; Michelle E Kho; George P Browman; Jako S Burgers; Francoise Cluzeau; Gene Feder; Béatrice Fervers; Ian D Graham; Jeremy Grimshaw; Steven E Hanna; Peter Littlejohns; Julie Makarski; Louise Zitzelsberger Journal: CMAJ Date: 2010-07-05 Impact factor: 8.262
Authors: B F Riecke; R Christensen; S Torp-Pedersen; M Boesen; H Gudbergsen; H Bliddal Journal: Osteoarthritis Cartilage Date: 2014-10 Impact factor: 6.576
Authors: Behnam Mohseny; Tim H Nijhuis; Caroline A Hundepool; Wim G Janssen; Ruud W Selles; J Henk Coert Journal: Arch Phys Med Rehabil Date: 2014-12-04 Impact factor: 3.966
Authors: Andrea S Klauser; Mathias J Pamminger; Ethan J Halpern; Mohamed M H Abd Ellah; Bernhard Moriggl; Mihra S Taljanovic; Christian Deml; Judith Sztankay; Guenter Klima; Leonhard Gruber; Werner R Jaschke Journal: Radiology Date: 2016-12-07 Impact factor: 11.105
Authors: Emilio Filippucci; Edoardo Cipolletta; Riccardo Mashadi Mirza; Marina Carotti; Andrea Giovagnoni; Fausto Salaffi; Marika Tardella; Andrea Di Matteo; Marco Di Carlo Journal: Radiol Med Date: 2019-03-09 Impact factor: 3.469
Authors: Luca Maria Sconfienza; Miraude Adriaensen; Domenico Albano; Maria Pilar Aparisi Gómez; Alberto Bazzocchi; Ian Beggs; Bianca Bignotti; Vito Chianca; Angelo Corazza; Danoob Dalili; Miriam De Dea; Jose Luis Del Cura; Francesco Di Pietto; Eleni Drakonaki; Fernando Facal de Castro; Dimitrios Filippiadis; Jan Gielen; Salvatore Gitto; Harun Gupta; Andrea S Klauser; Radhesh Lalam; Silvia Martin; Carlo Martinoli; Giovanni Mauri; Catherine McCarthy; Eugene McNally; Kalliopi Melaki; Carmelo Messina; Rebeca Mirón Mombiela; Benedikt Neubauer; Marina Obradov; Cyprian Olchowy; Davide Orlandi; Athena Plagou; Raquel Prada Gonzalez; Saulius Rutkauskas; Ziga Snoj; Alberto Stefano Tagliafico; Alexander Talaska; Violeta Vasilevska-Nikodinovska; Jelena Vucetic; David Wilson; Federico Zaottini; Marcello Zappia; Georgina Allen Journal: Eur Radiol Date: 2019-12-16 Impact factor: 5.315