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Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus

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.

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Abbreviations

ESSR:

European Society of Musculoskeletal Radiology

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The authors state that this work has not received any funding.

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Correspondence to Luca Maria Sconfienza.

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The scientific guarantor of this publication is Luca Maria Sconfienza.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because this study does not involve patients directly.

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Institutional Review Board approval was not required because this study does not involve patients directly.

Methodology

• Literature systematic review

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Sconfienza, L.M., Albano, D., Allen, G. et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 28, 5338–5351 (2018). https://doi.org/10.1007/s00330-018-5474-3

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Keywords

  • Ultrasonography
  • Musculoskeletal system
  • Elasticity imaging techniques
  • Guideline
  • Delphi technique