From 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.).
Radiology. 2019 May;291(2):420-426. doi: 10.1148/radiol.2019181695. Epub 2019 Apr 2.
Background Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by the formation of new bone along the anterolateral spinal column at four adjacent vertebral bodies. Purpose To propose and validate criteria for the early phase of DISH by using CT data from two large-scale retrospective cohorts, each with 5-year follow-up. Materials and Methods For this retrospective study, CT data at baseline and follow-up in 1367 patients (cohort I) from 2004 to 2011 were evaluated by two observers to define no DISH, early-stage DISH, and definite DISH on the basis of interval development of consecutive complete or incomplete bone bridges. An independent group of 2267 participants from the COPDGene cohort from 2008 to 2016 was used to validate the early DISH criteria (cohort II). The sensitivity and specificity of early DISH criteria were based on findings in the last CT study as the reference standard by using a nested case-control design. κ Values were calculated between seven readers and with a 3-month interval for one reader. Results Cohort I consisted of 100% men, with a mean age of 60.0 years ± 5.6 (standard deviation) and a mean time between baseline and follow-up CT of 5.0 years ± 1.1. Cohort II consisted of 51% men, with a mean age of 59.9 years ± 8.6 and a mean time between baseline and follow-up CT of 5.4 years ± 0.5. In the derivation cohort, 55 patients comprised the early DISH group. Early DISH was defined as the presence of a spinal segment with a complete bone bridge with an adjacent segment of at least a near-complete bone bridge and another adjacent segment with at least the presence of newly formed bone or when three or more adjacent segments were recorded as showing a near-complete bone bridge. In the validation cohort, sensitivity for early DISH (vs no DISH) was 96% (99 of 103 participants; 95% confidence interval [CI]: 90%, 99%). The corresponding specificity was 83% (1695 of 2034 participants; 95% CI: 82%, 85%). The Fleiss κ for interrater reliability was 0.78 (95% CI: 0.77, 0.78), and the κ for intrarater reliability was 0.89 (95% CI: 0.82, 0.96). Conclusion Early diffuse idiopathic skeletal hyperostosis (DISH) criteria had high sensitivity and specificity for predicting the development of DISH. © RSNA, 2019 See also the editorial by Block in this issue.
背景 弥漫特发性骨肥厚（DISH）的特征是在四个相邻椎体的前外侧脊柱形成新骨。目的 通过对来自两个大型回顾性队列的 CT 数据进行研究，提出并验证 DISH 早期阶段的标准，每个队列均有 5 年的随访。材料与方法 本回顾性研究中，对来自 2004 年至 2011 年的 1367 例患者（队列 I）的基线和随访 CT 数据进行了评估，两名观察者根据连续完整或不完整骨桥的间隔发展，定义无 DISH、早期 DISH 和明确 DISH。来自 2008 年至 2016 年 COPDGene 队列的 2267 例患者被纳入独立队列（队列 II），用于验证早期 DISH 标准。基于最后一次 CT 研究的结果，采用嵌套病例对照设计，根据发现将早期 DISH 标准作为参考标准，以确定早期 DISH 标准的敏感性和特异性。通过 κ 值评估 7 名读者之间以及一名读者在 3 个月时的一致性。结果 队列 I 均为男性，平均年龄为 60.0 岁±5.6（标准差），基线和随访 CT 之间的平均时间为 5.0 年±1.1。队列 II 中 51%为男性，平均年龄为 59.9 岁±8.6，基线和随访 CT 之间的平均时间为 5.4 年±0.5。在推导队列中，55 例患者组成了早期 DISH 组。早期 DISH 的定义为存在完整骨桥的脊柱节段，且与相邻节段至少有近乎完整的骨桥，另一个相邻节段至少有新骨形成，或者 3 个或更多相邻节段记录为显示近乎完整的骨桥。在验证队列中，早期 DISH（与无 DISH 相比）的敏感性为 96%（103 例患者中的 99 例；95%置信区间[CI]：90%，99%）。相应的特异性为 83%（2034 例患者中的 1695 例；95%CI：82%，85%）。观察者间的 Fleiss κ 为 0.78（95%CI：0.77，0.78），观察者内的 κ 为 0.89（95%CI：0.82，0.96）。结论 早期弥漫性特发性骨肥厚（DISH）标准对预测 DISH 的发展具有较高的敏感性和特异性。
