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Criteria for Early-Phase Diffuse Idiopathic Skeletal Hyperostosis: Development and Validation.

Jonneke S Kuperus1, Sytse F Oudkerk1, Wouter Foppen1

  • 1From the Departments of Orthopedic Surgery (J.S.K., W.P.G., J.W., F.C.O., J.J.V.) and Radiology (S.F.O., W.F., F.A.M.H., P.A.d.J.), University Medical Center Utrecht, Box 85500, 3508 GA, Utrecht, the Netherlands; and Department of Radiology, National Jewish Health, Denver, Colo (E.A.R., D.A.L.).

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New criteria for early diffuse idiopathic skeletal hyperostosis (DISH) were developed and validated using CT scans. These criteria demonstrate high sensitivity and specificity in identifying early-stage DISH, aiding in earlier diagnosis and management.

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Area of Science:

  • Radiology
  • Orthopedics
  • Rheumatology

Background:

  • Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by new bone formation along the anterolateral spine across four adjacent vertebral bodies.
  • Early detection of DISH is crucial for understanding its progression and potential management strategies.

Purpose of the Study:

  • To propose and validate criteria for the early phase of Diffuse Idiopathic Skeletal Hyperostosis (DISH).
  • To assess the accuracy of these early DISH criteria using computed tomography (CT) data from large retrospective cohorts.

Main Methods:

  • Retrospective analysis of CT data from 1367 patients (Cohort I) to define early DISH criteria based on bone bridge development.
  • Validation of proposed criteria in an independent cohort of 2267 participants (Cohort II) using a nested case-control design.
  • Calculation of sensitivity, specificity, and inter/intrarater reliability (κ values) for the developed criteria.

Main Results:

  • Early DISH was defined by specific patterns of complete, near-complete, or newly formed bone bridges across adjacent spinal segments.
  • The validated criteria demonstrated high sensitivity (96%) and specificity (83%) for detecting early DISH.
  • Excellent interrater (κ=0.78) and intrarater (κ=0.89) reliability was observed.

Conclusions:

  • The proposed criteria for early Diffuse Idiopathic Skeletal Hyperostosis (DISH) are effective and reliable.
  • These criteria show high sensitivity and specificity, facilitating earlier identification of DISH development.