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The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

European Radiology volume 30, pages 5281–5297 (2020)Cite this article

A Correction to this article was published on 17 July 2020

This article has been updated

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.

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Change history

  • 17 July 2020

    The original version of this article, published on 14 May 2020, unfortunately contained a mistake.

Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

α°:

Alpha angle

AI:

Acetabular index

AP:

Anteroposterior

COS:

Cross-over sign

CT:

Computed tomography

CTA:

CT arthrography

dMRA:

Direct MR arthrography

ESSR:

European Society of Musculoskeletal Radiology

FAI:

Femoroacetabular impingement

FAIS:

Femoroacetabular impingement syndrome

FHN:

Femoral head-neck

FO:

Femoral offset

FOV:

Field-of-view

HPS:

Hip preservation surgery

ISS:

Ischial spine sign

MRA:

Magnetic resonance arthrography

MRI:

Magnetic resonance imaging

OA:

Osteoarthritis

PWS:

Posterior wall sign

RefInt:

Reference intervals

W-CEA:

Centre-edge angle of Wiberg

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Authors and Affiliations

  1. Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal

    Vasco V. Mascarenhas & P. Diana Afonso

  2. Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal

    Miguel O. Castro

  3. Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal

    Paulo A. Rego

  4. Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland

    Reto Sutter

  5. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Luca Maria Sconfienza

  6. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Luca Maria Sconfienza

  7. Elite Sports Imaging SL, Madrid, Spain

    Ara Kassarjian

  8. Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland

    Florian Schmaranzer

  9. Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada

    Olufemi R. Ayeni

  10. Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Tobias Johannes Dietrich

  11. Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK

    Philip Robinson

  12. University of Leeds, Leeds, UK

    Philip Robinson

  13. NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK

    Philip Robinson

  14. Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany

    Marc-André Weber

  15. Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada

    Paul E. Beaulé

  16. Orthopädische Chirurgie München, Munich, Germany

    Michael Dienst

  17. Department of Radiology, Ghent University Hospital, Gent, Belgium

    Lennart Jans & Filip M. Vanhoenacker

  18. The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK

    Radhesh Lalam

  19. Medical School, University of Crete, Heraklion, Greece

    Apostolos H. Karantanas

  20. Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece

    Apostolos H. Karantanas

  21. Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland

    Iwona Sudoł-Szopińska

  22. Institute of Radiology, Kantonsspital Baden, Baden, Switzerland

    Suzanne Anderson

  23. Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia

    Suzanne Anderson

  24. Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria

    Iris Noebauer-Huhmann

  25. Department of Radiology, Antwerp University Hospital, Edegem, Belgium

    Filip M. Vanhoenacker

  26. Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium

    Filip M. Vanhoenacker

  27. Hospital CUF Descobertas, Lisbon, Portugal

    Pedro Dantas

  28. Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain

    Oliver Marin-Peña

  29. Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain

    Diego Collado

  30. Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain

    Marc Tey-Pons

  31. Department of Radiology, District Hospital St. Johann, St. Johann, Tyrol, Austria

    Ehrenfried Schmaranzer

  32. Department of Radiology, Hospital de la Ribera, Valencia, Spain

    Eva Llopis

  33. Department of Radiology, Clínica Cemtro, Madrid, Spain

    Mario Padron

  34. Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria

    Josef Kramer

  35. Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland

    Patrick O. Zingg

  36. Universitair Ziekenhuis Brussel, Brussels, Belgium

    Michel De Maeseneer

Authors
  1. Vasco V. Mascarenhas
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  2. Miguel O. Castro
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  3. Paulo A. Rego
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  4. Reto Sutter
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  5. Luca Maria Sconfienza
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  6. Ara Kassarjian
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  7. Florian Schmaranzer
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  8. Olufemi R. Ayeni
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  9. Tobias Johannes Dietrich
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  10. Philip Robinson
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  11. Marc-André Weber
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  12. Paul E. Beaulé
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  13. Michael Dienst
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  14. Lennart Jans
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  15. Radhesh Lalam
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  16. Apostolos H. Karantanas
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  17. Iwona Sudoł-Szopińska
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  18. Suzanne Anderson
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  19. Iris Noebauer-Huhmann
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  20. Filip M. Vanhoenacker
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  21. Pedro Dantas
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  22. Oliver Marin-Peña
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  23. Diego Collado
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  24. Marc Tey-Pons
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  25. Ehrenfried Schmaranzer
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  26. Eva Llopis
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  27. Mario Padron
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  28. Josef Kramer
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  29. Patrick O. Zingg
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  30. Michel De Maeseneer
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  31. P. Diana Afonso
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Corresponding author

Correspondence to Vasco V. Mascarenhas.

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Guarantor

The scientific guarantor of this publication is Dr. Vasco Vogado Mascarenhas.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

Several authors have significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional review board approval was not required because the study did not directly involve patients or any intervention.

Methodology

• Multicentre study

Additional information

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The original version of this article was revised: The spelling of Radhesh Lalam’s name was incorrect.

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Mascarenhas, V.V., Castro, M.O., Rego, P.A. et al. The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview. Eur Radiol 30, 5281–5297 (2020). https://doi.org/10.1007/s00330-020-06822-9

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  • DOI: https://doi.org/10.1007/s00330-020-06822-9

Keywords

  • Hip
  • Femoroacetabular impingement
  • Diagnostic imaging
  • Orthopaedics
  • Guideline