Volume 32, Issue 4 (Winter 2026)
Journal of Translational Medical Research. 2026, 32(4): 316-325 |
Back to browse issues page
Research code: 456170
Ethics code: IR.BUMS.REC.1399.331
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Imani Avaz M, Saremi Z, Soroosh Z, Ziaee A, Azarkar G. Prevalence of diffuse idiopathic skeletal hyperostosis based on chest computed tomography scans, 2019-2020. Journal of Translational Medical Research. 2026; 32 (4) :316-325
URL: http://journal.bums.ac.ir/article-1-3556-en.html
URL: http://journal.bums.ac.ir/article-1-3556-en.html
1- Internal Medicine Department of Radiology, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
2- Department of Internal Medicine (Rheumatology), Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
3- Department of Community and Family Medicine, Social Determinants of Health Research Center, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
4- Farabi Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
5- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran ,gh.azarkar@yahoo.com
2- Department of Internal Medicine (Rheumatology), Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran
3- Department of Community and Family Medicine, Social Determinants of Health Research Center, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
4- Farabi Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
5- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran ,
Abstract: (105 Views)
| Background and Aims: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory metabolic disorder of the spine characterized by progressive ligament ossification and increasing prevalence with age. Since chest CT is commonly performed for non-orthopedic indications, opportunistic assessment may provide a more accurate prevalence estimate. This study aimed to determine the prevalence and thoracic involvement pattern of DISH on chest CT at a referral hospital in Birjand, Iran. Materials and Methods: In this retrospective cross-sectional study, chest CT scans of 1,000 patients aged ≥16 years who had undergone imaging at Vali-Asr Hospital, Birjand, South Khorasan, Iran, between March 2019 and February 2020 were retrospectively reviewed. After exclusions, 949 records were analyzed. DISH was diagnosed using the Resnick–Niwayama criteria with independent review by two radiologists. Results: Among 949 patients, 125 cases had DISH (13.18%; 95% CI: 11.1–15.4). Mean age was higher in affected patients (70.8±13.8 years) than in those without DISH (66.2±10.5; P<0.001). Prevalence rates were 16.4% and 10.2% in males and females, respectively. Overweight (BMI 25–29.9) was present in 64% of cases. The most common comorbidities were hypertension (34.4%), dyslipidemia (24.0%), and diabetes (20.0%). Back pain (58.4%) and symptoms suggestive of spinal canal stenosis (57.6%) predominated. Thoracic involvement occurred at T5–T8 in 100%, T9–T12 in 95.2%, and T1–T4 in 47.2%. Vertebral fracture was observed in 15.2%, and posterior longitudinal ligament calcification in 4.0%. Conclusion: Thoracic DISH prevalence on chest CT was 13.18% and was associated with older age and male gender. These findings support opportunistic reporting of DISH during chest CT interpretation, cardiometabolic risk assessment, and referral when compressive symptoms are present. |
Type of Study: Original Article |
Subject:
Radiology
Received: 2025/10/18 | Accepted: 2026/01/21 | ePublished ahead of print: 2026/02/20 | ePublished: 2026/02/20
Received: 2025/10/18 | Accepted: 2026/01/21 | ePublished ahead of print: 2026/02/20 | ePublished: 2026/02/20
References
1. Hirasawa A, Wakao N, Kamiya M, Takeuchi M, Kawanami K, Murotani K, et al. The prevalence of diffuse idiopathic skeletal hyperostosis in Japan - the first report of measurement by CT and review of the literature. J Orthop Sci. 2016;21(3):287-90. DOI: 10.1016/j.jos.2016.02.001 [DOI:10.1016/j.jos.2016.02.001] [PMID]
2. Hiyama A, Katoh H, Sakai D, Sato M, Tanaka M, Watanabe M. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) assessed with whole-spine computed tomography in 1479 subjects. BMC Musculoskelet Disord. 2018;19(1):178. DOI: 10.1186/s12891-018-2108-5 [DOI:10.1186/s12891-018-2108-5] [PMID] []
3. Kiss C, O'Neill TW, Mituszova M, Szilagyi M, Poor G. The prevalence of diffuse idiopathic skeletal hyperostosis in a population-based study in Hungary. Scand J Rheumatol. 2002;31(4):226-9. DOI: 10.1080/030097402320318422 [DOI:10.1080/030097402320318422] [PMID]
4. Mader R, Pappone N, Baraliakos X, Eshed I, Sarzi-Puttini P, Atzeni F, et al. Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component. Curr Rheumatol Rep. 2021;23(1):6. DOI: 10.1007/s11926-020-00972-x [DOI:10.1007/s11926-020-00972-x] [PMID]
5. Mori K, Kasahara T, Mimura T, Nishizawa K, Nakamura A, Imai S. Prevalence of thoracic diffuse idiopathic skeletal hyperostosis (DISH) in Japanese: Results of chest CT-based cross-sectional study. J Orthop Sci. 2017;22(1):38-42. DOI: 10.1016/j.jos.2016.09.003 [DOI:10.1016/j.jos.2016.09.003] [PMID]
6. Kuperus JS, Mohamed Hoesein FAA, de Jong PA, Verlaan JJ. Diffuse idiopathic skeletal hyperostosis: Etiology and clinical relevance. Best Pract Res Clin Rheumatol. 2020;34(3):101527. DOI: 10.1016/j.berh.2020.101527 [DOI:10.1016/j.berh.2020.101527] [PMID]
7. Senolt L, Hulejova H, Krystufkova O, Forejtova S, Andres Cerezo L, Gatterova J, et al. Low circulating Dickkopf-1 and its link with severity of spinal involvement in diffuse idiopathic skeletal hyperostosis. Ann Rheum Dis. 2012;71(1):71-4. DOI: 10.1136/annrheumdis-2011-200357 [DOI:10.1136/annrheumdis-2011-200357] [PMID]
8. Kuperus JS, de Gendt EEA, Oner FC, de Jong PA, Buckens S, van der Merwe AE, et al. Classification criteria for diffuse idiopathic skeletal hyperostosis: a lack of consensus. Rheumatology (Oxford). 2017;56(7):1123-34. DOI: 10.1093/rheumatology/kex056 [DOI:10.1093/rheumatology/kex056] [PMID]
9. Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology. 1976;119(3):559-68. DOI: 10.1148/119.3.559 [DOI:10.1148/119.3.559] [PMID]
10. Mader R, Verlaan JJ, Eshed I, Bruges-Armas J, Puttini PS, Atzeni F, et al. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 2017;3(1):e000472. DOI: 10.1136/rmdopen-2017-000472 [DOI:10.1136/rmdopen-2017-000472] [PMID] []
11. Weng R, Guo H, Ma L, Lin T, Han W, Zhong X, et al. Global prevalence estimates of diffuse idiopathic skeletal hyperostosis: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2025;16:1517168. DOI: 10.3389/fendo.2025.1517168 [DOI:10.3389/fendo.2025.1517168] [PMID] []
12. Brikman S, Lubani Y, Mader R, Bieber A. High prevalence of diffuse idiopathic skeletal hyperostosis (DISH) among obese young patients - A retrospective observational study. Semin Arthritis Rheum. 2024;65:152356. DOI: 10.1016/j.semarthrit.2023.152356 [DOI:10.1016/j.semarthrit.2023.152356] [PMID]
13. Auethunsson AB, Eliasson GJ, Steingrimsson E, Aspelund T, Sigurdsson S, Launer L, et al. Diffuse idiopathic skeletal hyperostosis in elderly Icelanders and its association with the metabolic syndrome: the AGES-Reykjavik Study. Scand J Rheumatol. 2021;50(4):314-8. DOI: 10.1080/03009742.2020.1846779 [DOI:10.1080/03009742.2020.1846779] [PMID] []
14. Harlianto NI, Foppen W, Mohamed Hoesein FAA, Hol ME, Verlaan JJ, de Jong PA, et al. DISH as a marker for incident diabetes mellitus in cardiovascular disease patients. Rheumatology (Oxford). 2025;64(10):5287-94. DOI: 10.1093/rheumatology/keaf268 [DOI:10.1093/rheumatology/keaf268] [PMID] []
15. Takayuki M, Takashi H, Toshitaka Y, Hiroyuki I, Yu M, Satoru E, et al. Association between diffuse idiopathic skeletal hyperostosis and thoracic kyphosis in patients with cervical myelopathy: a retrospective observational study. BMC Musculoskelet Disord. 2021;22(1):964. DOI: 10.1186/s12891-021-04851-z [DOI:10.1186/s12891-021-04851-z] [PMID] []
16. Kuperus JS, Oudkerk SF, Foppen W, Mohamed Hoesein FA, Gielis WP, Waalwijk J, et al. Criteria for Early-Phase Diffuse Idiopathic Skeletal Hyperostosis: Development and Validation. Radiology. 2019;291(2):420-6. DOI: 10.1148/radiol.2019181695 [DOI:10.1148/radiol.2019181695] [PMID] []
17. Westerveld LA, van Ufford HM, Verlaan JJ, Oner FC. The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands. J Rheumatol. 2008;35(8):1635-8. URL: https://pubmed.ncbi.nlm.nih.gov/18528963/
18. Kim BS, Moon MS, Yoon MG, Kim ST, Kim SJ, Kim MS, et al. Prevalence of Diffuse Idiopathic Skeletal Hyperostosis Diagnosed by Whole Spine Computed Tomography: A Preliminary Study. Clin Orthop Surg. 2018;10(1):41-6. DOI: 10.4055/cios.2018.10.1.41 [DOI:10.4055/cios.2018.10.1.41] [PMID] []
19. Kagotani R, Yoshida M, Muraki S, Oka H, Hashizume H, Yamada H, et al. Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab. 2015;33(2):221-9. DOI: 10.1007/s00774-014-0583-9 [DOI:10.1007/s00774-014-0583-9] [PMID]
20. Bateman M, Hapuarachchi K, Pinto C, Doyle AJ. Diffuse idiopathic skeletal hyperostosis (DISH): Increased prevalence in Pacific Islanders. J Med Imaging Radiat Oncol. 2018;62(2):188-93. DOI: 10.1111/1754-9485.12679 [DOI:10.1111/1754-9485.12679] [PMID]
21. Sencan D, Elden H, Nacitarhan V, Sencan M, Kaptanoglu E. The prevalence of diffuse idiopathic skeletal hyperostosis in patients with diabetes mellitus. Rheumatol Int. 2005;25(7):518-21. DOI: 10.1007/s00296-004-0474-9 [DOI:10.1007/s00296-004-0474-9] [PMID]
22. Okada E, Ishihara S, Azuma K, Michikawa T, Suzuki S, Tsuji O, et al. Metabolic Syndrome is a Predisposing Factor for Diffuse Idiopathic Skeletal Hyperostosis. Neurospine. 2021;18(1):109-16. DOI: 10.14245/ns.2040350.175 [DOI:10.14245/ns.2040350.175] [PMID] []
23. Nishimura S, Hirai T, Nagoshi N, Yoshii T, Hashimoto J, Mori K, et al. Association between Severity of Diffuse Idiopathic Skeletal Hyperostosis and Ossification of Other Spinal Ligaments in Patients with Ossification of the Posterior Longitudinal Ligament. J Clin Med. 2021;10(20):4690. DOI: 10.3390/jcm10204690 [DOI:10.3390/jcm10204690] [PMID] []
24. Harlianto NI, Oosterhof N, Foppen W, Hol ME, Wittenberg R, van der Veen PH, et al. Diffuse idiopathic skeletal hyperostosis is associated with incident stroke in patients with increased cardiovascular risk. Rheumatology (Oxford). 2022;61(7):2867-74. DOI: 10.1093/rheumatology/keab835 [DOI:10.1093/rheumatology/keab835] [PMID] []
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Attribution-NoneCommercial CC BY-NC