Hirasawa Atsuhiko, Wakao Norimitsu, Kamiya Mitsuhiro, Takeuchi Mikinobu, Kawanami Katsuhisa, Murotani Kenta, Matsuo Toshihiro, Deie Masataka
Departments of Spine Center, Aichi Medical University, Nagakute, Aichi Pref., Japan.
Departments of Spine Center, Aichi Medical University, Nagakute, Aichi Pref., Japan.
J Orthop Sci. 2016 May;21(3):287-90. doi: 10.1016/j.jos.2016.02.001. Epub 2016 Mar 2.
Diffuse idiopathic skeletal hyperostosis (DISH) is prone to be accompanied by a spinal column fracture which is resistant to conservative therapy. This major characteristic of DISH is not recognized adequately by physicians, because the disease's detailed pathological condition has not yet been investigated. Therefore, the purposes of this study were to investigate the prevalence of DISH using computed tomography (CT), and to validate the reliability of CT interpretation.
Subjects were 558 patients (300 male and 258 female) who underwent both CT of chest to pelvis and x-ray of chest and abdomen from August 2011 to July 2012 at any department other than orthopedic surgery in our institution. The definition of DISH based on x-ray as well as CT was the presence of consecutive fused vertebral bodies according to Resnick's criteria. The prevalence of DISH based on both modalities was calculated in all subjects. For 107 subjects extracted at random, intra- (Cohen kappa) and inter-observer error (Fleiss kappa) were calculated and the levels of fused segments were investigated.
Ninety-eight of 558 subjects (17.6%) were diagnosed as DISH by x-ray, and 152 (27.2%) by CT. Among males, 70 of 300 subjects (23.3%) were diagnosed by x-ray, and 116 (38.7%) by CT. Among females, 28 of 258 subjects (10.9%) were diagnosed by x-ray and 36 (14.0%) by CT. The levels of fused segments were presented from thoracic spine to lumbar spine, especially the middle and lower thoracic spine. Cohen kappa of x-ray was 0.587, and that of CT was 0.825. Fleiss kappa of x-ray was 0.552, and that of CT was 0.643.
The prevalence of DISH based on CT was 27.1%, which was higher than that of x-ray. In addition, intra- and inter-observer error by review of CT was less than that of x-ray. CT evaluation would be a better method for precise understanding of the state of DISH.
弥漫性特发性骨肥厚（DISH）易伴发脊柱骨折，且对保守治疗抵抗。由于该病详细的病理状况尚未得到充分研究，医师对DISH的这一主要特征认识不足。因此，本研究的目的是利用计算机断层扫描（CT）调查DISH的患病率，并验证CT解读的可靠性。
研究对象为2011年8月至2012年7月期间在我院除骨科以外的任何科室接受胸部至骨盆CT及胸部和腹部X线检查的558例患者（男性300例，女性258例）。基于X线及CT的DISH定义为根据雷斯尼克标准存在连续的椎体融合。计算所有研究对象中基于两种检查方式的DISH患病率。对随机抽取的107例研究对象计算观察者内（科恩kappa值）及观察者间误差（弗莱斯kappa值），并研究融合节段的水平。
558例研究对象中，98例（17.6%）经X线诊断为DISH，152例（27.2%）经CT诊断为DISH。男性中，300例研究对象中有70例（23.3%）经X线诊断，116例（38.7%）经CT诊断。女性中，258例研究对象中有28例（10.9%）经X线诊断，36例（14.0%）经CT诊断。融合节段水平从胸椎至腰椎，尤其以胸段中下部为主。X线的科恩kappa值为0.587，CT的科恩kappa值为0.825。X线的弗莱斯kappa值为0.552，CT的弗莱斯kappa值为0.643。
基于CT的DISH患病率为27.1%，高于X线。此外，CT复查的观察者内及观察者间误差小于X线。CT评估是精确了解DISH病情的更好方法。
