CT-Based Evaluation of Diffuse Idiopathic Skeletal Hyperostosis in Adult Population; Prevalence, Associations and Interobserver Agreement

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and early-phase DISH across the lifespan of an American population

OBJECTIVES

DISH is a common musculoskeletal disorder; however, the imaging features and disease continuum from early to advanced stages is poorly understood. The purpose of this study was to evaluate the prevalence of DISH and early-phase DISH in an American population and to assess the extent and pattern of ectopic mineralization across the thoracic spine.

METHODS

Data were retrieved in collaboration with the Rochester Epidemiology Project. We conducted a retrospective image evaluation of a sample of individuals over 19 years of age with CT of the thoracic spine from a Northern US catchment area. Stratified random sampling by age and sex was used to populate the study. We examined the prevalence and extent of ectopic mineralization along the thoracic spine using previously established criteria.

RESULTS

A total of 1536 unique images (766 female and 770 male individuals) including 16 710 motion segments were evaluated for imaging features of the continuum of DISH. Collectively, 40.5% of all motion segments evaluated displayed evidence of ectopic mineralization in the thoracic spine. The prevalence of early-phase DISH was 13.2% (10.4% of female and 15.8% of male individuals). The prevalence of established DISH was 14.2% (7.4% of female and 20.9% of male individuals). Remarkable heterogeneity was detected in individuals within each disease classification, based on the extent of the thoracic spine affected and degree of mineralization.

CONCLUSIONS

The continuum of imaging features associated with DISH is detected in more than one in four adults and both sexes in an American population.

Comparison of radiological characteristics between diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a multicenter study

To evaluate the radiological differences between diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole spine computed tomography (CT), including the spine and sacroiliac joint (SIJ). The ossification and bridging of spinal ligament and fusion of the facet joint and SIJ were evaluated in 111 patients who were diagnosed with DISH and 27 patients with AS on the whole spine CT. The number of anterior bridging and shape of bridging (candle-wax-type/ smooth-type) were also evaluated. We further evaluated patients with DISH and AS by matching their age and sex. Complete SIJ fusion was more common in AS, whereas anterior and posterior bony bridging around SIJ was more common in DISH. However, 63% of patients with DISH had a partial or complete fusion. In spinal anterior bony bridging, the majority of patients with AS had the smooth-type, whereas those with DISH had the candle-wax-type. However, some of the patients with DISH (11%) had smooth-type. Intervertebral facet joint fusion is more common in AS. The number of anterior spinal bony bridging was greater in AS than in DISH, especially in the lumbar spine. These results are useful in differentiating DISH from AS and should therefore be considered when making a diagnosis.

Prevalence and characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in Italy

Purpose

Diffuse idiopathic skeletal hyperostosis (DISH) is a benign condition characterized by ossification of the spine and prominent enthesopathies. Highly heterogeneous epidemiological figures have been reported in the literature, while in Italy the largest study has been conducted in 1992. The aim of our research is to contribute updated information about prevalence of DISH in Italy and to describe the clinical and radiographic characteristics associated with the disorder.

Material and methods

A retrospective review of lumbosacral spine, thoracic spine and pelvis radiographs was performed. Consecutive patients visiting the emergency department of our Institution over 3 years were enrolled. Presence of DISH was evaluated applying the Resnick and Niwayama criteria. Clinical and radiological features were also assessed.

Results

We included 1012 individuals (60.6% women), and DISH was present in 130 cases. The overall prevalence of DISH was 12.8% (95% CI 10.8–15.1), with higher figures in the male sample (16.8%) than in females (10.3%). In binary logistic regression adjusted for age, BMI (OR 1.50, p < 0.001) diabetes (OR 1.85, p = 0.003), hypertension (OR 2.04, p = 0.007) ischiopubic enthesopathy (OR 7.08, p < 0.001), iliac crest enthesopathy (OR 4.63, p < 0.001) and greater trochanter enthesopathy (OR 3.51, p < 0.001), were significantly associated with the condition.

Conclusion

The prevalence of DISH observed in our study is consistent with previous literature, and we confirm that the disorder is more frequently retrieved in men and that it is associated with the presence of metabolic disorders and pelvic enthesopathy. Knowledge about the epidemiology and characteristics of DISH is needed to properly identify the condition.

The relationship of diffuse idiopathic skeletal hyperostosis, visceral fat accumulation, and other age-related diseases with the prevalent vertebral fractures in elderly men with castration-naïve prostate cancer

The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in prostate cancer patients and its relationship with prevalent vertebral fractures (PVF) has not yet been demonstrated. This study aimed to investigate the relationship of DISH, visceral fat accumulation, and other age-related diseases to PVF in elderly men with castration-naïve prostate cancer (CNPC). A total of 134 CNPC patients who were ≥65 years of age without bone metastases were registered in this study. DISH was found in 36.6% (49/134) of the patients in the study population. Patients with DISH were significantly older and had a lower total hip-bone mineral density (BMD) than those without DISH. On the other hand, there were no significant differences in fat distribution, prevalence of hypertension, dyslipidemia, diabetes, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c, prostate-specific antigen (PSA), or lumbar-BMD (L-BMD). A multivariate analysis of age, DISH, body mass index (BMI), visceral fat area (VFA), and total hip-BMD, which were significantly associated with PVF in a univariate analysis, showed that age (OR 1.11; p = .02) and DISH (OR 5.99; p = .0003) were independently associated with PVF. This study suggests that the presence of DISH may not be negligible when assessing the risk of vertebral fracture in prostate cancer patients before treatment.