Vasco V Mascarenhas1, Miguel O Castro2, Paulo A Rego3, Reto Sutter4, Luca Maria Sconfienza5,6, Ara Kassarjian7, Florian Schmaranzer8, Olufemi R Ayeni9, Tobias Johannes Dietrich10, Philip Robinson11,12,13, Marc-André Weber14, Paul E Beaulé15, Michael Dienst16, Lennart Jans17, Radhesh Lalam18, Apostolos H Karantanas19,20, Iwona Sudoł-Szopińska21, Suzanne Anderson22,23, Iris Noebauer-Huhmann24, Filip M Vanhoenacker17,25,26, Pedro Dantas27, Oliver Marin-Peña28, Diego Collado29, Marc Tey-Pons30, Ehrenfried Schmaranzer31, Eva Llopis32, Mario Padron33, Josef Kramer34, Patrick O Zingg35, Michel De Maeseneer36, P Diana Afonso37. 1. Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal. vmascarenhas@me.com. 2. Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal. 3. Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal. 4. Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. 5. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. 6. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy. 7. Elite Sports Imaging SL, Madrid, Spain. 8. Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland. 9. Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada. 10. Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland. 11. Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK. 12. University of Leeds, Leeds, UK. 13. NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK. 14. Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany. 15. Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada. 16. Orthopädische Chirurgie München, Munich, Germany. 17. Department of Radiology, Ghent University Hospital, Gent, Belgium. 18. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK. 19. Medical School, University of Crete, Heraklion, Greece. 20. Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece. 21. Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland. 22. Institute of Radiology, Kantonsspital Baden, Baden, Switzerland. 23. Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia. 24. Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria. 25. Department of Radiology, Antwerp University Hospital, Edegem, Belgium. 26. Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium. 27. Hospital CUF Descobertas, Lisbon, Portugal. 28. Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain. 29. Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain. 30. Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain. 31. Department of Radiology, District Hospital St. Johann, St. Johann, Tyrol, Austria. 32. Department of Radiology, Hospital de la Ribera, Valencia, Spain. 33. Department of Radiology, Clínica Cemtro, Madrid, Spain. 34. Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria. 35. Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland. 36. Universitair Ziekenhuis Brussel, Brussels, Belgium. 37. Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.
Abstract
OBJECTIVES: Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS: A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS: Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION: Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI. KEY POINTS: • FAI imaging literature is extensive although often of low level of evidence. • Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment. • MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
OBJECTIVES: Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS: A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS: Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION: Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI. KEY POINTS: • FAI imaging literature is extensive although often of low level of evidence. • Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment. • MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
Authors: Vasco V Mascarenhas; Miguel O Castro; P Diana Afonso; Paulo Rego; Michael Dienst; Reto Sutter; Florian Schmaranzer; Luca Sconfienza; Ara Kassarjian; Olufemi R Ayeni; Paul E Beaulé; Pedro Dantas; Radhesh Lalam; Marc-André Weber; Filip M Vanhoenacker; Tobias Johannes Dietrich; Lennart Jans; Philip Robinson; Apostolos H Karantanas; Iwona Sudoł-Szopińska; Suzanne Anderson; Iris Noebauer-Huhmann; Oliver Marin-Peña; Diego Collado; Marc Tey-Pons; Ehrenfried Schmaranzer; Mario Padron; Josef Kramer; Patrick O Zingg; Michel De Maeseneer; Eva Llopis Journal: Eur Radiol Date: 2021-01-07 Impact factor: 5.315
Authors: Florian Schmaranzer; Jennifer R Kallini; Mariana G Ferrer; Patricia E Miller; James D Wylie; Young-Jo Kim; Eduardo N Novais Journal: Clin Orthop Relat Res Date: 2021-05-01 Impact factor: 4.176
Authors: Lieve Morbée; Min Chen; Thomas Van Den Berghe; Eva Schiettecatte; Robert Gosselin; Nele Herregods; Lennart B O Jans Journal: Eur Radiol Date: 2022-01-23 Impact factor: 5.315
Authors: Dan Cohen; Abdullah Khan; Jeffrey Kay; David Slawaska-Eng; Mahmoud Almasri; Nicole Simunovic; Andrew Duong; Marc R Safran; Olufemi R Ayeni Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-06-26 Impact factor: 4.114
Authors: Cosimo Nardi; Luisa De Falco; Giuseppe Caracchini; Linda Calistri; Laura Mercatelli; Stefano Cristin; Chiara Lorini; Edoardo Cavigli; Nicholas Landini; Martina Orlandi; Christian Carulli; Vittorio Miele Journal: Jpn J Radiol Date: 2021-06-28 Impact factor: 2.374
Authors: Tobias Johannes Dietrich; Andoni Paul Toms; Luis Cerezal; Patrick Omoumi; Robert Downey Boutin; Jan Fritz; Rainer Schmitt; Maryam Shahabpour; Fabio Becce; Anne Cotten; Alain Blum; Marco Zanetti; Eva Llopis; Maciej Bień; Radhesh Krishna Lalam; P Diana Afonso; Vasco V Mascarenhas; Reto Sutter; James Teh; Grzegorz Pracoń; Milko C de Jonge; Jean-Luc Drapé; Marc Mespreuve; Alberto Bazzocchi; Guillaume Bierry; Danoob Dalili; Marc Garcia-Elias; Andrea Atzei; Gregory Ian Bain; Christophe L Mathoulin; Francisco Del Piñal; Luc Van Overstraeten; Robert M Szabo; Emmanuel J Camus; Riccardo Luchetti; Adrian Julian Chojnowski; Jörg G Grünert; Piotr Czarnecki; Fernando Corella; Ladislav Nagy; Michiro Yamamoto; Igor O Golubev; Jörg van Schoonhoven; Florian Goehtz; Maciej Klich; Iwona Sudoł-Szopińska Journal: Eur Radiol Date: 2021-06-08 Impact factor: 5.315