Which imaging findings suggest 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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Answer

The general term DISH emphasizes that the ligamentous ossification phenomenon is not limited to the spine. Exuberant ossification at sites of tendon, ligamentous, or joint capsule insertion (enthesitis) is strongly suggestive of the diagnosis. A tendency toward such ossification at any site of ligament and perhaps tendon insertion appears to exist. One study found pelvic enthesopathy on CT to be significantly more prevalent in patients with DISH compared with matched control patients. [35]

Enthesial reaction at the iliac crest and ischial tuberosities often is referred to as pelvic whiskering and typically is quite exuberant. Such whiskering was noted in two thirds of iliac crests studied and in 53% of ischial tuberosities. Enthesial reaction was noted in 42% of lesser and 36% of greater trochanters of the femur. Enthesial spurs at the site of insertion of the quadriceps mechanism into the patella were present in 29% of patients studied. Osseous bridging of fibula and tibia was noted in 10% of patients. Distal metacarpal and phalangeal capsular hyperostosis were present in 13% of patients with DISH. [16]

Katzman et al reported that DISH is associated with greater kyphosis in older men and women. However, DISH was not significantly associated with a change in kyphosis over 4-5 years, and in women followed over 15 years, those with DISH had less progression of kyphosis than those without DISH. [36]

For complete discussion, see Imaging in Diffuse Idiopathic Skeletal Hyperostosis (DISH).


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