Metabolic Factors in Diffuse Idiopathic Skeletal Hyperostosis – A Review of Clinical Data

Pillai, Sruti; Littlejohn, Geoffrey

doi:10.2174/1874312901408010116

Cited by 76 publications

(56 citation statements)

References 58 publications

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“…Prior anecdotal observations and case reports describe pulmonary restriction in cases of DISH [20]. Also the association of the metabolic syndrome and development of DISH has been previously suggested [12]. The cause of DISH is probably multifactorial and some evidence points to an underlying systemic low-grade inflammatory process [8–11].…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

et al. 2016

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ObjectiveTo evaluate and improve the interobserver agreement for the CT-based diagnosis of diffuse idiopathic skeletal hyperostosis (DISH).MethodsSix hundred participants of the CT arm of a lung cancer screening trial were randomly divided into two groups. The first 300 CTs were scored by five observers for the presence of DISH based on the original Resnick criteria for radiographs. After analysis of the data a consensus meeting was organised and the criteria were slightly modified regarding the definition of ‘contiguous’, the definition of ‘flowing ossifications’ and the viewing plane and window level. Subsequently, the second set of 300 CTs was scored by the same observers. κ ≥ 0.61 was considered good agreement.ResultsThe 600 male participants were on average 63.5 (SD 5.3) years old and had smoked on average 38.0 pack-years. In the first round κ values ranged from 0.32 to 0.74 and 7 out of 10 values were below 0.61. After the consensus meeting the interobserver agreement ranged from 0.51 to 0.86 and 3 out of 10 values were below 0.61. The agreement improved significantly.ConclusionsThis is the first study that reports interobserver agreement for the diagnosis of DISH on chest CT, showing mostly good agreement for modified Resnick criteria.Key Points• DISH is diagnosed on fluoroscopic and radiographic examinations using Resnick criteria • Evaluation of DISH on chest CT was modestly reproducible with the Resnick criteria • A consensus meeting and Resnick criteria modification improved inter-rater reliability for DISH • Reproducible CT criteria for DISH aids research into this poorly understood entity

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Section: Discussionmentioning

confidence: 99%

“…Specifically, the association of the metabolic syndrome and development of DISH has been shown by various authors [12]. The criteria Resnick established in 1976 stem from an era when computed tomography (CT) had yet to develop as a diagnostic tool.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

et al. 2016

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“…Consequently, there are no disease‐modifying treatments for DISH so clinical interventions are largely focused on symptom relief, with severe cases managed through surgical resection of mineralized tissues . Systemic metabolic disorders such as obesity, diabetes mellitus, high waist circumference, hypertension, hyperinsulinemia, dyslipidemia, and hyperuricemia have been associated with DISH . The prevalence of DISH is 15–25% of North Americans over the age of 50, with a greater prevalence per decade of age beyond 50 years and for males compared to females (∼2:1 ratio) .…”

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confidence: 99%

Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro‐ct analysis

Fournier

Norley

Pollmann

et al. 2019

Journal Orthopaedic Research

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Diffuse idiopathic skeletal hyperostosis (DISH) is a non‐inflammatory spondyloarthropathy identified radiographically by calcification of the ligaments and/or entheses along the anterolateral aspect of the vertebral column. The etiology and pathogenesis of calcifications are unknown, and the diagnosis of DISH is currently based on radiographic criteria associated with advanced disease. To characterize the features of calcifications associated with DISH, we used micro‐computed tomographic imaging to evaluate a cohort of 19 human cadaveric vertebral columns. Fifty‐three percent of the cohort (n = 10; 3 females, 7 males, mean age of death = 81 years, range 67–94) met the radiographic criteria for DISH, with calcification of four or more contiguous vertebral segments. In almost all cases, the lower thoracic regions (T8‐12) were affected by calcifications, consisting primarily of large, horizontal outgrowths of bony material. In contrast, calcifications localized to the upper thoracic regions demonstrated variability in their presentation and were categorized as either “continuous vertical bands” or “discontinuous‐patchy” lesions. In addition to the variable morphology of the calcifications, our analysis demonstrated remarkable heterogeneity in the densities of calcifications, ranging from internal components below the density of cortical bone to regions of hyper‐dense material that exceeded cortical bone. These findings establish that the current radiographic criteria for DISH capture heterogeneous presentations of ectopic spine calcification that can be differentiated based on morphology and density. These findings may indicate a naturally heterogenous disease, potential stage(s) in the natural progression of DISH, or distinct pathologies of ectopic calcifications. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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“…Although the etiology of DISH remains uncertain, it is associated with advanced age, type II diabetes mellitus, obesity (conditioned by calorically adequate diets, over-eating and low level of activity), genetic predisposition, metabolic factors and micro trauma (Cammisa et al 1998;Denko and Malemud 2006;El Miedany et al 2000;Kiss et al 2002;Mader 2003;Pappone et al 1996;Pillai and Littlejohn 2014;Resnick et al 1975). The age and dietary factors have been proved of particular interest for paleopathological investigations because they would be indicative of high social status.…”

Section: Introductionmentioning

confidence: 99%

Skeletal evidence of Diffuse Idiopathic Skeletal Hyperostosis (DISH) in a collective burial from Byzantine Greece

Tritsaroli

2018

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The paper reports on a collective burial from a 13th c. AD cist grave in Attica, Greece. The grave was located inside a basilica and held the remains of at least ten adults. Bone representation analysis showed secondary manipulation of previous deceased including long bone selection for reburial in the same grave and/or bones transported from a different burial place. Paleopathological analysis used macroscopy and radiology, and revealed several lesions on the axial and appendicular skeleton expressed mainly by spinal ligament ossification and multiple peripheral enthesopathies. Individuation of the remains pointed to a middle-aged male with DISH, a condition often correlated to high social rank. Byzantine period is marked by increasing development and prosperity in Greece including among others the creation of many local monastic centers. Although the precise social and professional profile of these individuals cannot be revealed, the combined investigation of skeletal and archaeological evidence suggests that the grave gathered the remains of individuals belonging to an upper class social group.

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Metabolic Factors in Diffuse Idiopathic Skeletal Hyperostosis – A Review of Clinical Data

Cited by 76 publications

References 58 publications

Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement

Ectopic spinal calcification associated with diffuse idiopathic skeletal hyperostosis (DISH): A quantitative micro‐ct analysis

Skeletal evidence of Diffuse Idiopathic Skeletal Hyperostosis (DISH) in a collective burial from Byzantine Greece

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