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Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects

Authors: Akihiko Hiyama, Hiroyuki Katoh, Daisuke Sakai, Masato Sato, Masahiro Tanaka, Masahiko Watanabe

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Computed tomography (CT) analyses have reported that the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in Japan is 8.7–27.1%. However, these data were obtained using chest-abdominal CT, and no evaluations of sagittal, coronal, and axial images using whole-spine CT have been reported. The aim of this study was to investigate the prevalence and characteristic of DISH by whole spinal CT.

Methods

Participants were patients who had experienced trauma who had undergone whole-spine CT scanning based on the initial clinical practice guidelines for trauma in our institute from April 2015 to February 2018. The subjects were > 20 years old and 1479 were included in the analysis. The presence and distribution of DISH and clinical parameters such as age and sex were reviewed retrospectively according to the location of DISH.

Results

The overall prevalence of DISH was 19.5% (n = 289). Subjects with DISH were older than those without. DISH was located in the thoracic spine in 65.1% and thoracolumbar spine in 24.2% of patients. More than 80% of ligamentous ossifications associated with DISH occurred at T8 (n = 255, 88%), T9 (n = 262, 91%), and T10 (n = 247, 85%). Most of the ossification occurred to the right anterior of the vertebral body, and there were few ossifications in the areas in contact with the artery and vein.

Conclusions

The prevalence of DISH based on whole-spine CT was 19.5%. Ossification was noted more often at T8, T9, and T10, and to the right anterior of the vertebral body. It is for the first time report that we have studied the location of ossification in detail using the axial images of whole spine CT. We hope this study will enhance the understanding of the characteristics of DISH.
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Literature
1.
go back to reference Okada E, Tsuji T, Shimizu K, Kato M, Fukuda K, Kaneko S, Ogawa J, Watanabe K, Ishii K, Nakamura M, et al. CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis. J Orthop Sci. 2017;22(1):3–9.CrossRefPubMed Okada E, Tsuji T, Shimizu K, Kato M, Fukuda K, Kaneko S, Ogawa J, Watanabe K, Ishii K, Nakamura M, et al. CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis. J Orthop Sci. 2017;22(1):3–9.CrossRefPubMed
2.
go back to reference Balling H, Weckbach A. Hyperextension injuries of the thoracolumbar spine in diffuse idiopathic skeletal hyperostosis. Spine. 2015;40(2):E61–7.CrossRefPubMed Balling H, Weckbach A. Hyperextension injuries of the thoracolumbar spine in diffuse idiopathic skeletal hyperostosis. Spine. 2015;40(2):E61–7.CrossRefPubMed
3.
go back to reference Rustagi T, Drazin D, Oner C, York J, Schroeder GD, Vaccaro AR, Oskouian RJ, Chapman JR. Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma. 2017;31(Suppl 4):S57–74.CrossRefPubMed Rustagi T, Drazin D, Oner C, York J, Schroeder GD, Vaccaro AR, Oskouian RJ, Chapman JR. Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma. 2017;31(Suppl 4):S57–74.CrossRefPubMed
4.
go back to reference Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology. 1975;115(3):513–24.CrossRefPubMed Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology. 1975;115(3):513–24.CrossRefPubMed
5.
go back to reference Littlejohn GO. Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis. Clin Rheumatol. 1985;4(3):294–300.CrossRefPubMed Littlejohn GO. Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis. Clin Rheumatol. 1985;4(3):294–300.CrossRefPubMed
6.
go back to reference Vezyroglou G, Mitropoulos A, Antoniadis C. A metabolic syndrome in diffuse idiopathic skeletal hyperostosis. A controlled study. J Rheumatol. 1996;23(4):672–6.PubMed Vezyroglou G, Mitropoulos A, Antoniadis C. A metabolic syndrome in diffuse idiopathic skeletal hyperostosis. A controlled study. J Rheumatol. 1996;23(4):672–6.PubMed
7.
go back to reference Julkunen H, Heinonen OP, Knekt P, Maatela J. The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol. 1975;4(1):23–7.CrossRefPubMed Julkunen H, Heinonen OP, Knekt P, Maatela J. The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol. 1975;4(1):23–7.CrossRefPubMed
8.
go back to reference Kim SK, Choi BR, Kim CG, Chung SH, Choe JY, Joo KB, Bae SC, Yoo DH, Jun JB. The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol. 2004;31(10):2032–5.PubMed Kim SK, Choi BR, Kim CG, Chung SH, Choe JY, Joo KB, Bae SC, Yoo DH, Jun JB. The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol. 2004;31(10):2032–5.PubMed
9.
go back to reference Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976;119(3):559–68.CrossRefPubMed Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976;119(3):559–68.CrossRefPubMed
10.
go back to reference Mata S, Chhem RK, Fortin PR, Joseph L, Esdaile JM. Comprehensive radiographic evaluation of diffuse idiopathic skeletal hyperostosis: development and interrater reliability of a scoring system. Semin Arthritis Rheum. 1998;28(2):88–96.CrossRefPubMed Mata S, Chhem RK, Fortin PR, Joseph L, Esdaile JM. Comprehensive radiographic evaluation of diffuse idiopathic skeletal hyperostosis: development and interrater reliability of a scoring system. Semin Arthritis Rheum. 1998;28(2):88–96.CrossRefPubMed
11.
go back to reference Cassim B, Mody GM, Rubin DL. The prevalence of diffuse idiopathic skeletal hyperostosis in African blacks. Br J Rheumatol. 1990;29(2):131–2.CrossRefPubMed Cassim B, Mody GM, Rubin DL. The prevalence of diffuse idiopathic skeletal hyperostosis in African blacks. Br J Rheumatol. 1990;29(2):131–2.CrossRefPubMed
12.
go back to reference Hirasawa A, Wakao N, Kamiya M, Takeuchi M, Kawanami K, Murotani K, Matsuo T, Deie M. The prevalence of diffuse idiopathic skeletal hyperostosis in Japan - the first report of measurement by CT and review of the literature. J Orthop Sci. 2016;21(3):287–90.CrossRefPubMed Hirasawa A, Wakao N, Kamiya M, Takeuchi M, Kawanami K, Murotani K, Matsuo T, Deie M. The prevalence of diffuse idiopathic skeletal hyperostosis in Japan - the first report of measurement by CT and review of the literature. J Orthop Sci. 2016;21(3):287–90.CrossRefPubMed
13.
go back to reference Kagotani R, Yoshida M, Muraki S, Oka H, Hashizume H, Yamada H, Enyo Y, Nagata K, Ishimoto Y, Teraguchi M, et al. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab. 2015;33(2):221–9.CrossRefPubMed Kagotani R, Yoshida M, Muraki S, Oka H, Hashizume H, Yamada H, Enyo Y, Nagata K, Ishimoto Y, Teraguchi M, et al. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab. 2015;33(2):221–9.CrossRefPubMed
14.
go back to reference Weinfeld RM, Olson PN, Maki DD, Griffiths HJ. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skelet Radiol. 1997;26(4):222–5.CrossRef Weinfeld RM, Olson PN, Maki DD, Griffiths HJ. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in two large American Midwest metropolitan hospital populations. Skelet Radiol. 1997;26(4):222–5.CrossRef
15.
go back to reference Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in the Netherlands. J Rheumatol. 2008;35(8):1635–8.PubMed Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in the Netherlands. J Rheumatol. 2008;35(8):1635–8.PubMed
16.
go back to reference Mori K, Kasahara T, Mimura T, Nishizawa K, Nakamura A, Imai S. Prevalence of thoracic diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: results of chest CT-based cross-sectional study. J Orthop Sci. 2017;22(1):38–42.CrossRefPubMed Mori K, Kasahara T, Mimura T, Nishizawa K, Nakamura A, Imai S. Prevalence of thoracic diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: results of chest CT-based cross-sectional study. J Orthop Sci. 2017;22(1):38–42.CrossRefPubMed
17.
go back to reference Oudkerk SF, de Jong PA, Attrach M, Luijkx T, Buckens CF, Mali WP, Oner FC, Resnick DL, Vliegenthart R, Verlaan JJ. Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement. Eur Radiol. 2017;27(1):188–94.CrossRefPubMed Oudkerk SF, de Jong PA, Attrach M, Luijkx T, Buckens CF, Mali WP, Oner FC, Resnick DL, Vliegenthart R, Verlaan JJ. Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement. Eur Radiol. 2017;27(1):188–94.CrossRefPubMed
18.
go back to reference Laroche M, Moulinier L, Arlet J, Arrue P, Rousseau H, Cantagrel A, Mazieres B. Lumbar and cervical stenosis. Frequency of the association, role of the ankylosing hyperostosis. Clin Rheumatol. 1992;11(4):533–5.CrossRefPubMed Laroche M, Moulinier L, Arlet J, Arrue P, Rousseau H, Cantagrel A, Mazieres B. Lumbar and cervical stenosis. Frequency of the association, role of the ankylosing hyperostosis. Clin Rheumatol. 1992;11(4):533–5.CrossRefPubMed
19.
go back to reference Sarzi-Puttini P, Atzeni F. New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol. 2004;16(3):287–92.CrossRefPubMed Sarzi-Puttini P, Atzeni F. New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol. 2004;16(3):287–92.CrossRefPubMed
20.
go back to reference Iwasawa T, Iwasaki K, Sawada T, Okada A, Ueyama K, Motomura S, Harata S, Inoue I, Toh S, Furukawa KI. Pathophysiological role of endothelin in ectopic ossification of human spinal ligaments induced by mechanical stress. Calcif Tissue Int. 2006;79(6):422–30.CrossRefPubMed Iwasawa T, Iwasaki K, Sawada T, Okada A, Ueyama K, Motomura S, Harata S, Inoue I, Toh S, Furukawa KI. Pathophysiological role of endothelin in ectopic ossification of human spinal ligaments induced by mechanical stress. Calcif Tissue Int. 2006;79(6):422–30.CrossRefPubMed
21.
go back to reference Denko CW, Malemud CJ. Body mass index and blood glucose: correlations with serum insulin, growth hormone, and insulin-like growth factor-1 levels in patients with diffuse idiopathic skeletal hyperostosis (DISH). Rheumatol Int. 2006;26(4):292–7.CrossRefPubMed Denko CW, Malemud CJ. Body mass index and blood glucose: correlations with serum insulin, growth hormone, and insulin-like growth factor-1 levels in patients with diffuse idiopathic skeletal hyperostosis (DISH). Rheumatol Int. 2006;26(4):292–7.CrossRefPubMed
22.
go back to reference Eckertova M, Krskova K, Penesova A, Radikova Z, Zlnay D, Rovensky J, Zorad S. Impaired insulin secretion and uptake in patients with diffuse idiopathic skeletal hyperostosis. Endocr Regul. 2009;43(4):149–55.PubMed Eckertova M, Krskova K, Penesova A, Radikova Z, Zlnay D, Rovensky J, Zorad S. Impaired insulin secretion and uptake in patients with diffuse idiopathic skeletal hyperostosis. Endocr Regul. 2009;43(4):149–55.PubMed
Metadata
Title
Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects
Authors
Akihiko Hiyama
Hiroyuki Katoh
Daisuke Sakai
Masato Sato
Masahiro Tanaka
Masahiko Watanabe
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2108-5

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