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Musculoskeletal
Diagnosis
Non-Trauma
Arthritis
Productive
DISH
DISH
Eva M. Escobedo, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Diffuse idiopathic skeletal hyperostosis (DISH)

        • Synonyms

          • Forestier disease, ankylosing hyperostosis

        • Definitions

          • Bone-forming diathesis primarily affecting spine with ossification of spinal ligaments and entheses in peripheral skeleton

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          • Diagnostic Criteria, Radiographic Only

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Kuperus JS et al: Diffuse idiopathic skeletal hyperostosis: etiology and clinical relevance. Best Pract Res Clin Rheumatol. 34(3):101527, 2020
                                        2. Pini SF et al: Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection? Clin Rheumatol. 38(4):1155-62, 2019
                                        3. Shah NG et al: Injuries to the rigid spine: what the spine surgeon wants to know. Radiographics. 39(2):449-66, 2019
                                        4. Hiyama A et al: Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects. BMC Musculoskelet Disord. 19(1):178, 2018
                                        5. Kim BS et al: Prevalence of diffuse idiopathic skeletal hyperostosis diagnosed by whole spine computed tomography: a preliminary study. Clin Orthop Surg. 10(1):41-6, 2018
                                        6. Kuperus JS et al: Anterior longitudinal ligament in diffuse idiopathic skeletal hyperostosis: ossified or displaced? J Orthop Res. 36(9):2491-6, 2018
                                        7. Kuperus JS et al: Classification criteria for diffuse idiopathic skeletal hyperostosis: a lack of consensus. Rheumatology (Oxford). 56(7):1123-34, 2017
                                        8. Kuperus JS et al: Histological characteristics of diffuse idiopathic skeletal hyperostosis. J Orthop Res. 35(1):140-6, 2017
                                        9. Leibushor N et al: CT abnormalities in the sacroiliac joints of patients with diffuse idiopathic skeletal hyperostosis. AJR Am J Roentgenol. 208(4):834-7, 2017
                                        10. Mader R et al: Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 3(1):e000472, 2017
                                        11. Oudkerk SF et al: Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement. Eur Radiol. 27(1):188-94, 2017
                                        12. Beyeler C et al: Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a controlled radiological study. BMC Musculoskelet Disord. 16:119, 2015
                                        13. Carmona R et al: MR imaging of the spine and sacroiliac joints for spondyloarthritis: influence on clinical diagnostic confidence and patient management. Radiology. 269(1):208-15, 2013
                                        14. Campagna R et al: Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR Am J Roentgenol. 192(4):987-95, 2009
                                        15. Taljanovic MS et al: Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR Am J Roentgenol. 193(3 Suppl):S10-9, Quiz S20-4, 2009
                                        16. Westerveld LA et al: Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 18(2):145-56, 2009
                                        17. Gokce A et al: Diffuse idiopathic skeletal hyperostosis as a cause of acute respiratory distress in early postoperative period of total knee arthroplasty. Arch Orthop Trauma Surg. 127(7):553-5, 2007
                                        18. Aydin E et al: Six cases of Forestier syndrome, a rare cause of dysphagia. Acta Otolaryngol. 126(7):775-8, 2006
                                        19. Ghosh B et al: Diffuse interstitial skeletal hyperostosis (DISH) in type 2 diabetes. J Assoc Physicians India. 52:994-6, 2004
                                        20. Mader R: Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum. 32(2):130-5, 2002
                                        21. Ehara S et al: Cervical spine injury in the elderly: imaging features. Skeletal Radiol. 30(1):1-7, 2001
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Diffuse idiopathic skeletal hyperostosis (DISH)

                                              • Synonyms

                                                • Forestier disease, ankylosing hyperostosis

                                              • Definitions

                                                • Bone-forming diathesis primarily affecting spine with ossification of spinal ligaments and entheses in peripheral skeleton

                                              IMAGING

                                              • General Features

                                                • Imaging Recommendations

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              • Microscopic Features

                                                                • Diagnostic Criteria, Radiographic Only

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Kuperus JS et al: Diffuse idiopathic skeletal hyperostosis: etiology and clinical relevance. Best Pract Res Clin Rheumatol. 34(3):101527, 2020
                                                                              2. Pini SF et al: Interobserver agreement using Schlapbach graded scale for diffuse idiopathic skeletal hyperostosis (DISH): can we reduce the cut-off point of vertebral affection? Clin Rheumatol. 38(4):1155-62, 2019
                                                                              3. Shah NG et al: Injuries to the rigid spine: what the spine surgeon wants to know. Radiographics. 39(2):449-66, 2019
                                                                              4. Hiyama A et al: Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects. BMC Musculoskelet Disord. 19(1):178, 2018
                                                                              5. Kim BS et al: Prevalence of diffuse idiopathic skeletal hyperostosis diagnosed by whole spine computed tomography: a preliminary study. Clin Orthop Surg. 10(1):41-6, 2018
                                                                              6. Kuperus JS et al: Anterior longitudinal ligament in diffuse idiopathic skeletal hyperostosis: ossified or displaced? J Orthop Res. 36(9):2491-6, 2018
                                                                              7. Kuperus JS et al: Classification criteria for diffuse idiopathic skeletal hyperostosis: a lack of consensus. Rheumatology (Oxford). 56(7):1123-34, 2017
                                                                              8. Kuperus JS et al: Histological characteristics of diffuse idiopathic skeletal hyperostosis. J Orthop Res. 35(1):140-6, 2017
                                                                              9. Leibushor N et al: CT abnormalities in the sacroiliac joints of patients with diffuse idiopathic skeletal hyperostosis. AJR Am J Roentgenol. 208(4):834-7, 2017
                                                                              10. Mader R et al: Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 3(1):e000472, 2017
                                                                              11. Oudkerk SF et al: Diagnosis of diffuse idiopathic skeletal hyperostosis with chest computed tomography: inter-observer agreement. Eur Radiol. 27(1):188-94, 2017
                                                                              12. Beyeler C et al: Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a controlled radiological study. BMC Musculoskelet Disord. 16:119, 2015
                                                                              13. Carmona R et al: MR imaging of the spine and sacroiliac joints for spondyloarthritis: influence on clinical diagnostic confidence and patient management. Radiology. 269(1):208-15, 2013
                                                                              14. Campagna R et al: Fractures of the ankylosed spine: MDCT and MRI with emphasis on individual anatomic spinal structures. AJR Am J Roentgenol. 192(4):987-95, 2009
                                                                              15. Taljanovic MS et al: Imaging characteristics of diffuse idiopathic skeletal hyperostosis with an emphasis on acute spinal fractures: review. AJR Am J Roentgenol. 193(3 Suppl):S10-9, Quiz S20-4, 2009
                                                                              16. Westerveld LA et al: Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 18(2):145-56, 2009
                                                                              17. Gokce A et al: Diffuse idiopathic skeletal hyperostosis as a cause of acute respiratory distress in early postoperative period of total knee arthroplasty. Arch Orthop Trauma Surg. 127(7):553-5, 2007
                                                                              18. Aydin E et al: Six cases of Forestier syndrome, a rare cause of dysphagia. Acta Otolaryngol. 126(7):775-8, 2006
                                                                              19. Ghosh B et al: Diffuse interstitial skeletal hyperostosis (DISH) in type 2 diabetes. J Assoc Physicians India. 52:994-6, 2004
                                                                              20. Mader R: Clinical manifestations of diffuse idiopathic skeletal hyperostosis of the cervical spine. Semin Arthritis Rheum. 32(2):130-5, 2002
                                                                              21. Ehara S et al: Cervical spine injury in the elderly: imaging features. Skeletal Radiol. 30(1):1-7, 2001