Luca Maria Sconfienza1,2, Miraude Adriaensen3, Domenico Albano4,5, Georgina Allen6,7, Maria Pilar Aparisi Gómez8,9, Alberto Bazzocchi10, Ian Beggs11, Bianca Bignotti12, Vito Chianca4, Angelo Corazza4,13, Danoob Dalili14,15, Miriam De Dea16, Jose Luis Del Cura17,18, Francesco Di Pietto19, Eleni Drakonaki20,21, Fernando Facal de Castro22,23, Dimitrios Filippiadis24, Jan Gielen25,26, Salvatore Gitto27, Harun Gupta28, Andrea S Klauser29,30, Radhesh Lalam31, Silvia Martin32,33, Carlo Martinoli12,34, Giovanni Mauri35, Catherine McCarthy15,36, Eugene McNally36, Kalliopi Melaki37, Carmelo Messina4,38, Rebeca Mirón Mombiela39,40, Benedikt Neubauer41,42, Marina Obradov43, Cyprian Olchowy44, Davide Orlandi45, Raquel Prada Gonzalez46, Saulius Rutkauskas47, Ziga Snoj48, Alberto Stefano Tagliafico12,49, Alexander Talaska50, Violeta Vasilevska-Nikodinovska51,52, Jelena Vucetic23,39, David Wilson6,7, Federico Zaottini34, Marcello Zappia53,54, Athena Plagou55. 1. IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy. io@lucasconfienza.it. 2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy. io@lucasconfienza.it. 3. Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands. 4. IRCCS Istituto Ortopedico Galeazzi, 20161, Milano, Italy. 5. Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy. 6. St Luke's Radiology Oxford Ltd, Oxford, UK. 7. University of Oxford, Oxford, UK. 8. Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand. 9. Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain. 10. Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy. 11. Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK. 12. Ospedale Policlinico San Martino, 16132, Genoa, Italy. 13. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy. 14. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 15. The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK. 16. UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy. 17. Department of Radiology, Donostia University Hospital, 20014, Donostia/San Sebastian, Spain. 18. University of the Basque Country (UPV/EHU), Leioa, Spain. 19. Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, (CE), Italy. 20. Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece. 21. Department of Anatomy, Medical School of the European University of Cyprus, Engomi, Cyprus. 22. IBERORAD 1895 S.L., 08021, Barcelona, Spain. 23. Department of Radiology, General University Hospital of Valencia, Valencia, Spain. 24. 2nd Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Athens, Greece. 25. University of Antwerp, Antwerp, Belgium. 26. University of Antwerp Hospital (UZA), Edegem, Belgium. 27. Università degli Studi di Milano, Milan, Italy. 28. Leeds Teaching Hospitals, Leeds, UK. 29. Medical University Innsbruck, Innsbruck, Austria. 30. Department of Radiology, Innsbruck, Austria. 31. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK. 32. Hospital Son Llatzer, Palma de Mallorca, Spain. 33. Universidad de las Islas Baleares Medicine, Palma, Balearic Islands, Spain. 34. University of Genoa - DISSAL Department of Health Sciences, Genoa, Italy. 35. Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy. 36. Oxford Musculoskeletal Radiology, Oxford, UK. 37. Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany. 38. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy. 39. Department of Physiology, Universidad de Valencia/INCLIVA, 46010, Valencia, Spain. 40. Herlev og Gentofte Hospital Radiologisk Afdeling, Herlev Ringvej 75, opgang 51, Herlev, Denmark. 41. Radiology, Medical University of Vienna, Vienna, Austria. 42. Ordensklinikum Linz, Linz, Austria. 43. Sint Maartenskliniek, 9011, Nijmegen, 6500GM, The Netherlands. 44. Department of Oral Surgery, Wroclaw Medical University, Wrocław, Poland. 45. Ospedale Evangelico Internazionale Genova, Genoa, Italy. 46. Department of Radiology, Hospital POVISA, Vigo, Spain. 47. Radiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania. 48. Department of Radiology, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, 1000, Slovenia. 49. Department of Health Sciences, University of Genoa, 16132, Genoa, Italy. 50. Department of Radiology, AUVA Trauma Centre, Vienna, Austria. 51. Medical Faculty, University "Ss.Cyril and Methodius", Skopje, North Macedonia. 52. University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia. 53. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy. 54. Varelli Institute, Naples, Italy. 55. Department of Radiology, Private Institution of Ultrasonography, Athens, Greece.
Abstract
BACKGROUND: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence. METHODS: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed. RESULTS: Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%). CONCLUSIONS: This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus. KEY POINTS: • An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb • Two statements reached the highest level of evidence • Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).
BACKGROUND: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence. METHODS: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed. RESULTS: Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%). CONCLUSIONS: This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus. KEY POINTS: • An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb • Two statements reached the highest level of evidence • Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).
Authors: John P Walsh; Terence P Farrell; John Hynes; Nicola Hughes; Ciara O'Byrne; Stephen J Eustace Journal: Semin Musculoskelet Radiol Date: 2018-11-06 Impact factor: 1.777
Authors: Jordan M Brown; Corrie M Yablon; Yoav Morag; Catherine J Brandon; Jon A Jacobson Journal: Radiographics Date: 2016 Mar-Apr Impact factor: 5.333
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