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Imaging Findings Suggestive of Axial Spondyloarthritis in Diffuse Idiopathic Skeletal Hyperostosis
Augustin Latourte1, Stéphane Charlon2, Adrien Etcheto1
1Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France.
Objective:
To describe the magnetic resonance imaging (MRI) findings in diffuse idiopathic skeletal hyperostosis (DISH) patients and to assess the proportion of DISH patients whose MRI findings would fulfill the Assessment of Spondyloarthritis International Society (ASAS) criteria for a positive MRI of axial spondyloarthritis (SpA).
Methods:
This study involved all DISH patients who had a spine or sacroiliac (SI) joint MRI performed between January 2009 and December 2014. Sociodemographic and clinical data were collected. Available radiographs and MRI were analyzed and blindly scored by an experienced reader, using the Spondyloarthritis Research Consortium of Canada (SPARCC) scores for both spine and SI joint MRI.
Results:
A total of 53 symptomatic DISH patients was included in the analysis. The mean ± SD SPARCC score of the spine was 18.3 ± 23.4. Thirty-five patients (67.3%) had at least 1 fatty corner. Thirty patients (57.7%) met the ASAS definition of a spine MRI suggestive of axial SpA, but only 6 patients (15.8%) with an available SI joint MRI had sacroiliitis according to ASAS criteria. Only 1 patient (3.3%) had ≥3 erosions on the SI joint.
Conclusion:
Inflammatory lesions of the spine are common on the MRI of symptomatic DISH patients, and more than half fulfilled the ASAS criteria for a spine MRI suggestive of axial SpA. However, only a few patients met the ASAS definition of active sacroiliitis, suggesting that MRI of the SI joint but not of the spine might allow the differential diagnosis of DISH versus axial SpA in the elderly.
Insights
Magnetic resonance imaging (MRI) in diffuse idiopathic skeletal hyperostosis (DISH) shows common spinal inflammatory lesions. Many DISH patients meet criteria for axial spondyloarthritis (SpA) on spine MRI, but few on SI joint MRI, aiding differential diagnosis.
Area of Science:
- Radiology
- Rheumatology
- Orthopedics
Background:
- Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in older adults, characterized by calcification and ossification of ligaments and entheses.
- Distinguishing DISH from axial spondyloarthritis (SpA) can be challenging, particularly in symptomatic patients where imaging findings may overlap.
Purpose of the Study:
- To characterize magnetic resonance imaging (MRI) findings in patients diagnosed with diffuse idiopathic skeletal hyperostosis (DISH).
- To evaluate the proportion of DISH patients who meet the Assessment of Spondyloarthritis International Society (ASAS) criteria for a positive MRI of axial spondyloarthritis (SpA).
Main Methods:
- Retrospective analysis of spine and sacroiliac (SI) joint MRI scans from 53 symptomatic DISH patients (2009-2014).
- Independent, blinded scoring of MRI findings using the Spondyloarthritis Research Consortium of Canada (SPARCC) scores.
- Assessment of MRI findings against ASAS criteria for axial SpA.
Main Results:
- A significant proportion of DISH patients (67.3%) exhibited at least one fatty corner on spinal MRI.
- Over half of the patients (57.7%) met ASAS criteria for a spine MRI suggestive of axial SpA.
- Only a small percentage of patients (15.8%) met ASAS criteria for active sacroiliitis on SI joint MRI.
Conclusions:
- Spinal inflammatory lesions are frequently observed on MRI in symptomatic DISH patients.
- While many DISH patients fulfill ASAS criteria for axial SpA on spine MRI, SI joint findings are less common, suggesting MRI of the SI joint is more valuable for differentiating DISH from axial SpA in elderly populations.