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The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview.

  • Mascarenhas, Vasco V1
  • Castro, Miguel O2
  • Rego, Paulo A3
  • Sutter, Reto4
  • Sconfienza, Luca Maria5, 6
  • Kassarjian, Ara7
  • Schmaranzer, Florian8
  • Ayeni, Olufemi R9
  • Dietrich, Tobias Johannes10
  • Robinson, Philip11, 12, 13
  • Weber, Marc-André14
  • Beaulé, Paul E15
  • Dienst, Michael16
  • Jans, Lennart17
  • Lalam, Radhesh18
  • Karantanas, Apostolos H19, 20
  • Sudoł-Szopińska, Iwona21
  • Anderson, Suzanne22, 23
  • Noebauer-Huhmann, Iris24
  • Vanhoenacker, Filip M17, 25, 26
  • And 11 more
  • 1 Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal. [email protected] , (Portugal)
  • 2 Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal. , (Portugal)
  • 3 Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal. , (Portugal)
  • 4 Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. , (Switzerland)
  • 5 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. , (Italy)
  • 6 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy. , (Italy)
  • 7 Elite Sports Imaging SL, Madrid, Spain. , (Spain)
  • 8 Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland. , (Switzerland)
  • 9 Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada. , (Canada)
  • 10 Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland. , (Switzerland)
  • 11 Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK.
  • 12 University of Leeds, Leeds, UK.
  • 13 NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
  • 14 Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany. , (Germany)
  • 15 Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada. , (Canada)
  • 16 Orthopädische Chirurgie München, Munich, Germany. , (Germany)
  • 17 Department of Radiology, Ghent University Hospital, Gent, Belgium. , (Belgium)
  • 18 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK.
  • 19 Medical School, University of Crete, Heraklion, Greece. , (Greece)
  • 20 Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece. , (Greece)
  • 21 Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland. , (Poland)
  • 22 Institute of Radiology, Kantonsspital Baden, Baden, Switzerland. , (Switzerland)
  • 23 Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia. , (Australia)
  • 24 Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria. , (Austria)
  • 25 Department of Radiology, Antwerp University Hospital, Edegem, Belgium. , (Belgium)
  • 26 Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium. , (Belgium)
  • 27 Hospital CUF Descobertas, Lisbon, Portugal. , (Portugal)
  • 28 Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain. , (Spain)
  • 29 Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain. , (Spain)
  • 30 Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain. , (Spain)
  • 31 Department of Radiology, District Hospital St. Johann, St. Johann, Tyrol, Austria. , (Austria)
  • 32 Department of Radiology, Hospital de la Ribera, Valencia, Spain. , (Spain)
  • 33 Department of Radiology, Clínica Cemtro, Madrid, Spain. , (Spain)
  • 34 Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria. , (Austria)
  • 35 Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland. , (Switzerland)
  • 36 Universitair Ziekenhuis Brussel, Brussels, Belgium. , (Belgium)
  • 37 Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal. , (Portugal)
Published Article
European Radiology
Publication Date
Oct 01, 2020
DOI: 10.1007/s00330-020-06822-9
PMID: 32405754


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. 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. 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'. 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. • 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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