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

  • Musculoskeletal
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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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Authors and Affiliations

  1. Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy

    Luca Maria Sconfienza & Carmelo Messina

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy

    Luca Maria Sconfienza & Carmelo Messina

  3. Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy

    Domenico Albano

  4. Department of Radiology, St Lukes Radiology Oxford Ltd, Oxford, UK

    Georgina Allen & David Wilson

  5. Diagnostic and Interventional Radiology, “Rizzoli” Orthopaedic Institute, Bologna, Italy

    Alberto Bazzocchi

  6. Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132, Genova, Italy

    Bianca Bignotti, Carlo Martinoli, Federica Rossi & Alberto Stefano Tagliafico

  7. Department of Advanced Biomedical Sciences, Università degli studi Federico II, via Pansini 5, 80131, Napoli, Italy

    Vito Chianca

  8. Hospital General Universitario de Valencia, Ave. Tres Cruces 2, 46014, Valencia, Spain

    Fernando Facal de Castro, Rebeca Mirón Mombiela & Jelena Vucetic

  9. Independent MSK radiology practice, Heraklion, Crete, Greece

    Elena E. Drakonaki

  10. Department of Radiology, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain

    Elena Gallardo

  11. Radiology and S.P.O.R.T.S. Department, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium

    Jan Gielen

  12. Department of Radiology, Medical University Innsbruck, Section Rheumatology and Sports Imaging, Innsbruck, Austria

    Andrea Sabine Klauser

  13. Ospedale Policlinico San Martino, Genova, Italy

    Carlo Martinoli & Alberto Stefano Tagliafico

  14. Division of Interventional Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milano, Italy

    Giovanni Mauri

  15. Oxford Musculoskeletal Radiology, Oxford, UK

    Eugene McNally

  16. Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain

    Rebeca Mirón Mombiela & Jelena Vucetic

  17. S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale, Corso Solferino 1A, 16122, Genova, Italy

    Davide Orlandi

  18. Department of Radiology, Private Institution of Ultrasonography, Athens, Greece

    Athena Plagou

  19. Department of Radiology, W. Dega Orthopaedic and Rehabilitation University Hospital of Karol Marcinkowski University of Medical Sciences, Poznan, Poland

    Magdalena Posadzy

  20. Hospital Universitario Marqués de Valdecilla, Santander, Spain

    Rosa de la Puente

  21. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Monique Reijnierse

  22. Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania

    Saulius Rutkauskas

  23. Ljubljana University Medical Centre, Clinical Institute of Radiology, Ljubljana, Slovenia

    Ziga Snoj

Authors
  1. Luca Maria Sconfienza
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  2. Domenico Albano
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  3. Georgina Allen
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  4. Alberto Bazzocchi
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  5. Bianca Bignotti
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  7. Fernando Facal de Castro
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  9. Elena Gallardo
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  11. Andrea Sabine Klauser
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  12. Carlo Martinoli
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  13. Giovanni Mauri
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  14. Eugene McNally
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  15. Carmelo Messina
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  16. Rebeca Mirón Mombiela
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  17. Davide Orlandi
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  19. Magdalena Posadzy
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  20. Rosa de la Puente
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  21. Monique Reijnierse
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  22. Federica Rossi
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  23. Saulius Rutkauskas
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  24. Ziga Snoj
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  25. Jelena Vucetic
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  26. David Wilson
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  27. Alberto Stefano Tagliafico
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Corresponding author

Correspondence to Luca Maria Sconfienza.

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Guarantors

The scientific guarantor of this publication is Luca Maria Sconfienza.

Conflict of interest

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.

Informed consent

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

Ethical approval

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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  • DOI: https://doi.org/10.1007/s00330-018-5474-3

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