Diagnosis of Diffuse Idiopathic Skeletal Hyperostosis with Chest Computed Tomography: Inter-observer Agreement

Overview

Journal Eur Radiol

Specialty Radiology

Date 2016 Apr 22

PMID 27097788

Citations 18

Authors

S F Oudkerk

Pim A de Jong

M Attrach

T Luijkx

C F Buckens

W P Th M Mali

F C Oner

D L Resnick

R Vliegenthart

J J Verlaan

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate and improve the interobserver agreement for the CT-based diagnosis of diffuse idiopathic skeletal hyperostosis (DISH).

Methods: Six hundred participants of the CT arm of a lung cancer screening trial were randomly divided into two groups. The first 300 CTs were scored by five observers for the presence of DISH based on the original Resnick criteria for radiographs. After analysis of the data a consensus meeting was organised and the criteria were slightly modified regarding the definition of 'contiguous', the definition of 'flowing ossifications' and the viewing plane and window level. Subsequently, the second set of 300 CTs was scored by the same observers. κ ≥ 0.61 was considered good agreement.

Results: The 600 male participants were on average 63.5 (SD 5.3) years old and had smoked on average 38.0 pack-years. In the first round κ values ranged from 0.32 to 0.74 and 7 out of 10 values were below 0.61. After the consensus meeting the interobserver agreement ranged from 0.51 to 0.86 and 3 out of 10 values were below 0.61. The agreement improved significantly.

Conclusions: This is the first study that reports interobserver agreement for the diagnosis of DISH on chest CT, showing mostly good agreement for modified Resnick criteria.

Key Points: • DISH is diagnosed on fluoroscopic and radiographic examinations using Resnick criteria • Evaluation of DISH on chest CT was modestly reproducible with the Resnick criteria • A consensus meeting and Resnick criteria modification improved inter-rater reliability for DISH • Reproducible CT criteria for DISH aids research into this poorly understood entity.

Citing Articles

Significant overlap of inflammatory and degenerative features on imaging among patients with degenerative disc disease, diffuse idiopathic skeletal hyperostosis and axial spondyloarthritis: a real-life cohort study.

Ziade N, Udod M, Kougkas N, Tsiami S, Baraliakos X Arthritis Res Ther. 2024; 26(1):147.

PMID: 39097721 PMC: 11297750. DOI: 10.1186/s13075-024-03359-w.

Disease-specific definitions of new bone formation on spine radiographs: a systematic literature review.

Gazel U, Ayan G, Hryciw N, Delorme J, Hepworth E, Sampaio M Rheumatol Adv Pract. 2024; 8(2):rkae061.

PMID: 38827363 PMC: 11142627. DOI: 10.1093/rap/rkae061.

Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) and early-phase DISH across the lifespan of an American population.

Fournier D, Leung A, Battie M, Seguin C Rheumatology (Oxford). 2023; 63(4):1153-1161.

PMID: 37481711 PMC: 10986808. DOI: 10.1093/rheumatology/kead362.

Diffuse Idiopathic Skeletal Hyperostosis and Ankylosing Spondylitis: A Challenging Case and Review of the Literature.

Ghossan R, Zebouni S, Farah T, Fayad F J Radiol Case Rep. 2022; 16(11):1-16.

PMID: 36518159 PMC: 9714563. DOI: 10.3941/jrcr.v16i11.4634.

Diffuse Idiopathic Skeletal Hyperostosis Prevalence, Characteristics, and Associated Comorbidities: A Cross-Sectional Study of 1815 Whole Spine CT Scans.

Ahmed O, Ramachandran K, Patel Y, Dhanapaul S, Meena J, Shetty A Global Spine J. 2022; 14(4):1201-1209.

PMID: 36289007 PMC: 11289539. DOI: 10.1177/21925682221136844.

References

Mata S, Chhem R, Fortin P, Joseph L, Esdaile J . Comprehensive radiographic evaluation of diffuse idiopathic skeletal hyperostosis: development and interrater reliability of a scoring system. Semin Arthritis Rheum. 1998; 28(2):88-96. DOI: 10.1016/s0049-0172(98)80041-3. View

Littlejohn G . Insulin and new bone formation in diffuse idiopathic skeletal hyperostosis. Clin Rheumatol. 1985; 4(3):294-300. DOI: 10.1007/BF02031611. View

Sarzi-Puttini P, Atzeni F . New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis). Curr Opin Rheumatol. 2004; 16(3):287-92. DOI: 10.1097/00002281-200405000-00021. View

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. View

Yoshida M, Kibe A, Aizawa H, Matsumoto K, Inoue H, Koto H . [Diffuse idiopathic skeletal hyperostosis with fibrobullous change in upper lung lobes and dyspnea due to limitation of thoracic cage]. Nihon Kokyuki Gakkai Zasshi. 1999; 37(10):823-8. View

Alshamari M, Geijer M, Norrman E, Liden M, Krauss W, Wilamowski F . Low dose CT of the lumbar spine compared with radiography: a study on image quality with implications for clinical practice. Acta Radiol. 2015; 57(5):602-11. DOI: 10.1177/0284185115595667. View

Brennan P, Silman A . Statistical methods for assessing observer variability in clinical measures. BMJ. 1992; 304(6840):1491-4. PMC: 1882212. DOI: 10.1136/bmj.304.6840.1491. View

Vezyroglou G, Mitropoulos A, Antoniadis C . A metabolic syndrome in diffuse idiopathic skeletal hyperostosis. A controlled study. J Rheumatol. 1996; 23(4):672-6. View

Miyazawa N, Akiyama I . Ossification of the ligamentum flavum of the cervical spine. J Neurosurg Sci. 2007; 51(3):139-44. View

10.

Utsinger P . Diffuse idiopathic skeletal hyperostosis. Clin Rheum Dis. 1985; 11(2):325-51. View

11.

Mader R, Verlaan J, Buskila D . Diffuse idiopathic skeletal hyperostosis: clinical features and pathogenic mechanisms. Nat Rev Rheumatol. 2013; 9(12):741-50. DOI: 10.1038/nrrheum.2013.165. View

12.

Pillai S, Littlejohn G . Metabolic factors in diffuse idiopathic skeletal hyperostosis - a review of clinical data. Open Rheumatol J. 2015; 8:116-28. PMC: 4293739. DOI: 10.2174/1874312901408010116. View

13.

Westerveld L, Quarles van Ufford H, Verlaan J, Oner F . The prevalence of diffuse idiopathic skeletal hyperostosis in an outpatient population in The Netherlands. J Rheumatol. 2008; 35(8):1635-8. View

14.

Ten Cate O, Snell L, Carraccio C . Medical competence: the interplay between individual ability and the health care environment. Med Teach. 2010; 32(8):669-75. DOI: 10.3109/0142159X.2010.500897. View

15.

Laroche M, Moulinier L, ARLET J, Arrue P, Rousseau H, Cantagrel A . Lumbar and cervical stenosis. Frequency of the association, role of the ankylosing hyperostosis. Clin Rheumatol. 1992; 11(4):533-5. DOI: 10.1007/BF02283114. View

16.

Kim S, Choi B, Kim C, Chung S, Choe J, Joo K . The prevalence of diffuse idiopathic skeletal hyperostosis in Korea. J Rheumatol. 2004; 31(10):2032-5. View

17.

Julkunen H, Heinonen O, Knekt P, Maatela J . The epidemiology of hyperostosis of the spine together with its symptoms and related mortality in a general population. Scand J Rheumatol. 1975; 4(1):23-7. View

18.

van Iersel C, de Koning H, Draisma G, Mali W, Scholten E, Nackaerts K . Risk-based selection from the general population in a screening trial: selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer multi-slice CT screening trial (NELSON). Int J Cancer. 2006; 120(4):868-74. DOI: 10.1002/ijc.22134. View

19.

Westerveld L, van Bemmel J, Dhert W, Oner F, Verlaan J . Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2013; 14(5):729-40. DOI: 10.1016/j.spinee.2013.06.038. View

20.

Westerveld L, Verlaan J, Oner F . Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2008; 18(2):145-56. PMC: 2899332. DOI: 10.1007/s00586-008-0764-0. View