Department of Radiology, Centro Hospitalar Universitário do Algarve, Sítio do Poço Seco, Portimão, 8500-338, Portugal.
Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal.
Eur Radiol. 2021 Jul;31(7):4652-4668. doi: 10.1007/s00330-020-07501-5. Epub 2021 Jan 7.
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.
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.
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.
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.
• 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.
由于缺乏高级别的证据，髋关节撞击综合征（FAI）的影像学诊断仍然存在争议，这导致患者管理存在很大差异。尽管在临床实践中具有挑战性，但在 FAI 成像中优化方案和技术细节至关重要。本协议的目的是使用相关文献综述驱动的正式共识技术，就 FAI 成像提出基于专家的声明。提供了用于 FAI 评估的成像技术的选择和使用建议，以及有关放射学和 MRI 分类的指导。
使用 Delphi 方法评估 30 名小组（肌肉骨骼放射科医生和骨科医生）成员之间的一致性，并达成共识。同意了 44 个问题，并将其分为五个主要主题，并分发了最近的相关文献，以生成回答陈述。对所有陈述进行了证据评估，小组在 4 轮 Delphi 中对每个陈述的一致性进行评分。达成了“团体共识”，“团体同意”或“无共识”。
生成了 47 个语句，并达成了 45 个团体共识。生成了 22 个与“成像技术”相关的语句，8 个关于“放射学评估”的语句和 12 个关于“MRI 评估”的语句达成共识。关于“超声”的 2 个相关语句未达成共识。
制定了髋关节撞击综合征影像学的首个国际共识。研究人员和临床医生在髋关节撞击综合征和髋关节相关疼痛方面工作时，可以使用这些建议来指导，制定和实施全面的，基于证据的影像学方案和分类。
放射学评估推荐用于 FAI 的初步评估，而专用协议的 MRI 是评估这种情况的金标准影像学技术。
FAI 评估的 MRI 方案应包括单侧小 FOV 与放射状成像，股骨扭转评估以及涵盖整个骨盆的液体敏感序列。
其他成像方法（例如超声或 CT）在 FAI 中的明确作用尚未得到很好的定义。
