What is the role of imaging studies in the diagnosis of diffuse idiopathic skeletal hyperostosis (DISH)?

Updated: Oct 23, 2018
  • Author: Bruce M Rothschild, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Diffuse idiopathic skeletal hyperostosis (DISH) involves the thoracic vertebrae in 100% of cases, the lumbar vertebrae in 68-90%, and the cervical vertebrae in 65-78%. Ligamentous ossification affects both sides of the lumbar vertebral column but tends to be unilateral in the human spine.

Prominence of DISH on the right lateral aspect of the thoracic spine is apparently related to aortic pulsations. Left-sided overgrowth is much reduced, also probably because of the influence of aortic pulsations, an idea supported by the notation of left-sided prominence in individuals with situs inversus (left-sided thoracic aorta).

The earliest sign of DISH appears to be new bone formation adjacent to the midportion of the vertebral body, a phenomenon often below the limits of radiologic detection. Recognition of DISH is facilitated by its separation from the body of the vertebrae. Radiologically, this appears as a radiodense line paralleling the longitudinal axis of the spine but separated by a clearly definable space.

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