Miguel O Castro1, Vasco V Mascarenhas2, P Diana Afonso2, Paulo Rego3, Florian Schmaranzer4, Reto Sutter5, Ara Kassarjian6, Luca Sconfienza7,8, Michael Dienst9, Olufemi R Ayeni10, Paul E Beaulé11, Pedro Dantas12, Radhesh Lalam13, Marc-André Weber14, Filip M Vanhoenacker15,16,17, Tobias Johannes Dietrich18, Lennart Jans17, Philip Robinson19,20, Apostolos H Karantanas21, Iwona Sudoł-Szopińska22, Suzanne Anderson23,24, Iris Noebauer-Huhmann25, Oliver Marin-Peña26, Diego Collado27, Marc Tey-Pons28, Ehrenfried Schmaranzer29, Mario Padron30, Josef Kramer31, Patrick O Zingg32, Michel De Maeseneer33, Eva Llopis34. 1. Department of Radiology, Centro Hospitalar Universitário do Algarve, Sítio do Poço Seco, Portimão, 8500-338, Portugal. migkastro@yahoo.com. 2. Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal. 3. Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal. 4. Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland. 5. Balgrist University Hospital, University of Zurich, Zurich, Switzerland. 6. Elite Sports Imaging, SL, Madrid, Spain. 7. RCCS Istituto Ortopedico Galeazzi, Milan, Italy. 8. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy. 9. Orthopädische Chirurgie München, München, Germany. 10. Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada. 11. Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada. 12. Hospital CUF Descobertas, Lisbon, Portugal. 13. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK. 14. Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany. 15. Department of Radiology, Antwerp University Hospital, Edegem, Belgium. 16. Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium. 17. Department of Radiology, Ghent University Hospital, Ghent, Belgium. 18. Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Gallen, Switzerland. 19. Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK. 20. University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK. 21. Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece. 22. Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland. 23. Institute of Radiology, Kantonsspital Baden, Baden, Switzerland. 24. The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia. 25. Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria. 26. Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain. 27. Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain. 28. Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain. 29. Department of Radiology, District Hospital St. Johann, Tyrol, Austria. 30. Department of Radiology, Clínica Cemtro, Madrid, Spain. 31. Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria. 32. Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland. 33. Universitair Ziekenhuis Brussel, Brussels, Belgium. 34. Department of Radiology, Hospital de la Ribera, Valencia, Spain.
Abstract
OBJECTIVES: Imaging diagnosis of femoroacetabular impingement (FAI) remains controversial due to a lack of high-level evidence, leading to significant variability in patient management. Optimizing protocols and technical details is essential in FAI imaging, although challenging in clinical practice. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal consensus techniques driven by relevant literature review. Recommendations on the selection and use of imaging techniques for FAI assessment, as well as guidance on relevant radiographic and MRI classifications, are provided. METHODS: The Delphi method was used to assess agreement and derive consensus among 30 panel members (musculoskeletal radiologists and orthopedic surgeons). Forty-four questions were agreed on and classified into five major topics and recent relevant literature was circulated, in order to produce answering statements. The level of evidence was assessed for all statements and panel members scored their level of agreement with each statement during 4 Delphi rounds. Either "group consensus," "group agreement," or "no agreement" was achieved. RESULTS: Forty-seven statements were generated and group consensus was reached for 45. Twenty-two statements pertaining to "Imaging techniques" were generated. Eight statements on "Radiographic assessment" and 12 statements on "MRI evaluation" gained consensus. No agreement was reached for the 2 "Ultrasound" related statements. CONCLUSION: The first international consensus on FAI imaging was developed. Researchers and clinicians working with FAI and hip-related pain may use these recommendations to guide, develop, and implement comprehensive, evidence-based imaging protocols and classifications. KEY POINTS: • Radiographic evaluation is recommended for the initial assessment of FAI, while MRI with a dedicated protocol is the gold standard imaging technique for the comprehensive evaluation of this condition. • The MRI protocol for FAI evaluation should include unilateral small FOV with radial imaging, femoral torsion assessment, and a fluid sensitive sequence covering the whole pelvis. • The definite role of other imaging methods in FAI, such as ultrasound or CT, is still not well defined.
OBJECTIVES: Imaging diagnosis of femoroacetabular impingement (FAI) remains controversial due to a lack of high-level evidence, leading to significant variability in patient management. Optimizing protocols and technical details is essential in FAI imaging, although challenging in clinical practice. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal consensus techniques driven by relevant literature review. Recommendations on the selection and use of imaging techniques for FAI assessment, as well as guidance on relevant radiographic and MRI classifications, are provided. METHODS: The Delphi method was used to assess agreement and derive consensus among 30 panel members (musculoskeletal radiologists and orthopedic surgeons). Forty-four questions were agreed on and classified into five major topics and recent relevant literature was circulated, in order to produce answering statements. The level of evidence was assessed for all statements and panel members scored their level of agreement with each statement during 4 Delphi rounds. Either "group consensus," "group agreement," or "no agreement" was achieved. RESULTS: Forty-seven statements were generated and group consensus was reached for 45. Twenty-two statements pertaining to "Imaging techniques" were generated. Eight statements on "Radiographic assessment" and 12 statements on "MRI evaluation" gained consensus. No agreement was reached for the 2 "Ultrasound" related statements. CONCLUSION: The first international consensus on FAI imaging was developed. Researchers and clinicians working with FAI and hip-related pain may use these recommendations to guide, develop, and implement comprehensive, evidence-based imaging protocols and classifications. KEY POINTS: • Radiographic evaluation is recommended for the initial assessment of FAI, while MRI with a dedicated protocol is the gold standard imaging technique for the comprehensive evaluation of this condition. • The MRI protocol for FAI evaluation should include unilateral small FOV with radial imaging, femoral torsion assessment, and a fluid sensitive sequence covering the whole pelvis. • The definite role of other imaging methods in FAI, such as ultrasound or CT, is still not well defined.
Authors: Rintje Agricola; Marinus P Heijboer; Sita M A Bierma-Zeinstra; Jan A N Verhaar; Harrie Weinans; Jan H Waarsing Journal: Ann Rheum Dis Date: 2012-06-23 Impact factor: 19.103
Authors: James R Ross; Jeffrey J Nepple; Marc J Philippon; Bryan T Kelly; Christopher M Larson; Asheesh Bedi Journal: Am J Sports Med Date: 2014-07-24 Impact factor: 6.202