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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. [ABSTRACT FROM AUTHOR]

Objectives: To perform an online survey about the use of magnetic resonance arthrography (MRA) in clinical practice.Methods: We administered an online survey to all 1,550 members of the European Society of Musculoskeletal Radiology (ESSR) about MRA asking ten different questions. Subgroup analysis was performed between general and orthopaedic hospitals using χ2 and Mann-Whitney U statistics.Results: One-hundred forty-eight answers were included (148/1,550, 9.5% of ESSR members). A median of 3,000 (interquartile range: 1,567.5-5,324.5) musculoskeletal MR examinations and a median of 125.5 MRAs (50.75-249) per institution were performed in 2016. Ratio between MRA and musculoskeletal MR was 4.7% (1.6%-9.0%). Using MRA, the most investigated joint was the shoulder followed by the hip (96.6%). The most common indications were the evaluation of instability, labrum, and rotator cuff (85.1%). Fluoroscopy represented the preferred injection guidance. A self-prepared mixture of Gadolinium/saline is preferred in general hospitals, while pre-diluted Gadolinium-based syringes are mainly used in orthopaedic hospitals (P=.010). The number of MRA performed at orthopaedic hospitals (284;83.75-449.50) was higher (P=.006) than that performed at general hospitals (115.50;44.75-234.25).Conclusions: One out of twenty MR examinations is a MRA, with higher prevalence in orthopaedic hospitals. The shoulder and the hip are the most investigated joints. Instability, labrum, and cuff are the most common indications.Key Points: • The most common MRAs are shoulder and hip (96.6% of answers). • Most common clinical indications for MRA are instability, labrum, and rotator cuff (85.1% of answers). • Fluoroscopy represents the preferred guidance to inject joints (61.0% of answers). • The median number of MRA performed at orthopaedic hospitals (n=284) was significantly higher (P=.006) than that performed at general hospitals (n=115.50). • A self-prepared mixture of Gadolinium/saline solution is preferred in general hospitals (64.8%) compared to orthopaedic hospitals (36.0%; P=0.010). [ABSTRACT FROM AUTHOR]