E1289. DISH: The Forgotten and Neglected Spondyloarthropathy
A. Describe the Resnick and other criteria for diagnosing DISH and, treatment, if needed.
B. Review the extra-thoracic bony and non-bony involvement of DISH and its prevalence along the spine; cervical, thoracic, and lumbar.
C. Understand the associating complications from compression of adjacent structures and correlation with Metabolic Syndrome.
D. Utilizing imaging and clinical data in deciphering DISH from ankylosing spondylitis.
E. Review the relevant radiology literature on this topic.
Educational Goals / Teaching Points
1 - Radiologists and trainees should have a working knowledge of Diffuse Idiopathic Skeletal Hyperostosis (DISH) and its associated extra-thoracic bony and non-bony findings.
2 - Radiologists must understand prevalence of DISH along the spine; cervical, thoracic, and lumbar.
3 - Radiologists should be alert for co-morbidities of DISH via compression of adjacent structures and its associations with metabolic syndrome.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Resnick criteria of flowing candle-wax calcification and bridging osteophytes, with modified criteria focusing on the angle formed by osteophyte and vertebral bodies.
Extra-thoracic bony involvement with bony excrescences at sites near peripheral joints and increased chances of hypertrophic changes with primary osteoarthritis.
Prevalences specifically along the right lateral aspect of thoracic spine, due to aortic pulsations on left side, with sparing of the apophyseal joints and costovertebral joints.
Underappreciated phenomenon with back pain and impaired physical function and direct compression of adjacent cervical organs, (mass effect from large osteophytes leading to recurrent laryngeal nerve injury and inflammation/fibrosis of esophageal wall).
Images demonstrating the following:
CT cervical spine of DISH with indentation on the posterior hypopharyngeal wall.
CT lumbosacral spine of DISH with ossification of the iliolumbar ligaments.
CT of cervical, thoracic, and lumbar spine with classic "candle-wax" appearance and bridging osteophytes.
After reviewing this exhibit, learners should be able to identify the imaging characteristics of DISH and its associated complications.