Cammisa M, De Serio A, Guglielmi G
Diagnostic Imaging Department, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo (FG), Italy.
Eur J Radiol. 1998 May;27 Suppl 1:S7-11. doi: 10.1016/s0720-048x(98)00036-9.
To describe the axial and appendicular skeleton findings of diffuse idiopathic skeletal hyperostosis. To analyze the role of conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of this condition. To discuss the differential diagnosis and diagnostic pitfalls of this disease.
The involvement of vertebral and extravertebral sites including the pelvis, calcaneum, ulnar olecranon, and patella is frequently found in the literature. The lesions described are the anterior and lateral ossification of the spine, hyperostosis at sites of tendon and ligament insertion, ligamentous ossification, and periarticular osteophytes. The criteria for the diagnosis of diffuse idiopathic skeletal hyperostosis involving the spine are: flowing ossification along the anterior and anterolateral aspects of at least four contiguous vertebrae, preserved intervertebral disc height, no bony ankylosis of the posterior spinal facet joints, and finally no erosion, sclerosis or bony ankylosis of the sacroiliac joints.
The disease has about the same frequency in men (65%) and women (35%); it is most common in the thoracic spine and occurs less frequently in the lumbar and cervical spine. The disease most commonly presents in the sixth and seventh decades of life and its estimated frequency in the elderly is 5-15%. Signs and symptoms include stiffness and pain in the back, dysphagia due to direct esophageal compression/distorsion, pain related to associated tendinitis, myelopathy related to core compression associated to the ossification of the posterior longitudinal ligament, and pain related to vertebral complications--e.g. fracture/subluxation.
While conventional radiography clearly confirms the diagnosis of diffuse idiopathic skeletal hyperostosis, CT and MRI better detect associated findings (e.g. ossification of the posterior longitudinal ligament) and complications (e.g. spinal cord compressive myelomalacia).
描述弥漫性特发性骨肥厚的中轴骨和附肢骨骼表现。分析传统X线摄影、计算机断层扫描（CT）和磁共振成像（MRI）在该疾病诊断中的作用。探讨该疾病的鉴别诊断及诊断陷阱。
文献中经常发现椎体和椎体外部位受累，包括骨盆、跟骨、尺骨鹰嘴和髌骨。所描述的病变包括脊柱的前侧和外侧骨化、肌腱和韧带附着部位的骨质增生、韧带骨化以及关节周围骨赘。弥漫性特发性骨肥厚累及脊柱的诊断标准为：至少四个连续椎体的前侧和前外侧出现连续的骨化，椎间盘高度保留，后脊柱小关节无骨性强直，最后骶髂关节无侵蚀、硬化或骨性强直。
该疾病在男性（65%）和女性（35%）中的发病率大致相同；最常见于胸椎，在腰椎和颈椎中较少见。该疾病最常出现在60至70岁之间，在老年人中的估计发病率为5% - 15%。体征和症状包括背部僵硬和疼痛、因食管直接受压/扭曲导致的吞咽困难、与相关肌腱炎有关的疼痛、与后纵韧带骨化相关的脊髓受压导致的脊髓病以及与椎体并发症（如骨折/半脱位）有关的疼痛。
虽然传统X线摄影能明确确诊弥漫性特发性骨肥厚，但CT和MRI能更好地检测相关发现（如后纵韧带骨化）和并发症（如脊髓压迫性脊髓软化）。
