Pelvic enthesopathy on CT is significantly more prevalent in patients with diffuse idiopathic skeletal hyperostosis (DISH) compared with matched control patients

Abstract

The purpose of this study is to evaluate the prevalence of pelvic enthesopathy on computed tomography (CT) in patients with DISH compared to matched control group. Pelvic CT examinations of patients with DISH (Resnick criteria) were retrospectively evaluated for the presence of enthesophytes at four entheseal sites bilaterally: ischial tuberosity, pubis, greater trochanter, and anterior superior iliac spine (ASIS). This was compared with age- and gender-matched control group of consecutive patients with <2 flowing osteophytes on CT along the entire spine. Multivariate analysis of variance (ANOVA) was applied to examine the degree of difference between pelvic enthesopathy in DISH patients and controls and to estimate the potential predictive ability of the different findings. Logistic regression analysis was used to estimate the odds ratio of the studied findings. Pelvic CTs of 210 patients (149:61, M:F; average age, 72.3 years) were evaluated: DISH group, 104 patients (74:30, M:F); matched control group, 106 patients (75:31, M:F). Mean total and local enthesopathy scores were significantly higher in the DISH group compared with the control group (total 5.03:1.9; ASIS 1.58:0.55; pubis 0.94:0.36; ischial tuberosity 1.47:0.76; greater trochanter 1.04:0.24; p < 0.001). ASIS and greater trochanter enthesophytes were the most robust contributors that significantly distinguished between patients with DISH and those without DISH. Prominent enthesophytes were more common among DISH patients (DISH:controls, 52:13, p = 0.02). Prominent pelvic enthesophytes detected on CT have a strong discriminating power between DISH and non-DISH patients. Results imply that pelvic enthesopathy may be included in the radiographic criteria for DISH.

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

“…Interestingly, the proportion of individuals presenting features of insertional enthesopathy was elevated in the DISH group. In line with the available literature, we noted a significant association between DISH and ischiopubic enthesopathy, iliac crest enthesopathy, greater trochanter enthesopathy, hip OA, osteitis pubis and calcification of interspinous ligament, remarking how in particular pelvic enthesopathy is highly characteristic of this condition [ 22 , 56 ]. The entheseal involvement, along with the hyperostotic spinal changes, might generate confusion in the radiological differential diagnosis between DISH and axial SpA, although the two diseases have completely distinct radiographic features [ 57 – 59 ].…”

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

“…Pelvic enthesopathies are considered highly characteristic of DISH and have been shown to be significantly more prevalent and more prominent in DISH subjects compared with controls 9. Indeed, pelvic insertional tendon enthesopathy on pelvic radiographs and on CT, seen as an ossification or calcification of the entheses, has been found to be a good indicator of the presence of radiographical spinal DISH 10 11.…”

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“…The most common imaging modality for confirming DISH at present is the use of plain radiography. Meanwhile, CT scan has recently been reported to possess higher sensitivity in detecting DISH and evaluating the structural changes associated with condition, while MRI is more sensitive in capturing the soft tissues of the spine, proving it to be a useful instrument in the differential diagnosis of DISH and Ankylosing Spondylitis (AS) since MRI is capable of detecting inflammation that is typical in AS [5,14,15]. Recently, bone scintigraphy with hybrid images of single photon emission computed tomography-computed tomography (SPECT-CT) has been introduced to provide accurate anatomical and functional imaging and precise localization of the spinal lesion by determining the location with increased radiotracer uptake [5].…”