YENİ GÖRÜNTÜLEME ÖLÇÜTLERİNE GÖRE YAYGIN İDYOPATİK İSKELET HİPEROSTOZUNUN PREVALANSI VE BU HASTALARDA SAKROİLYAK EKLEMLERİN GÖRÜNTÜLEME BULGULARI

Abstract

DISH is a clinically important entity that is included in the differential diagnosis of seronegative spondyloarthropathies. A recent study has defined the diagnostic criteria for the early stage of spinal involvement of DISH. In this study, we investigated the frequency of early-stage and classic DISH and the pelvic enthesophyte burden in these patients using CT scans of the thorax and abdomen. Between October 6 and 25, 2023, we included 636 patients who underwent thorax CT examinations on our hospital's CT Optima and CT GE Optima devices and met the inclusion criteria. The study was conducted in collaboration with Hacettepe University Radiology and Rheumatology Departments. We collected demographic and clinical findings and CT imaging findings and created a general data set. 50.5% of the patients were female and the mean age was 58.99±14.06 years. In the first stage, thorax CT scans were evaluated and patients were grouped into 3 different groups as no-DISH, early-stage DISH and classic DISH. The distribution of the final diagnostic groups in the study group was as follows: 432 no-DISH, 106 early-stage DISH, 98 classic DISH. The weighted kappa coefficient of interobserver agreement calculated over a total of 636 participants for DISH status was κ=0.655 (95% CI=0.584-0.726). The weighted kappa coefficient of intraobserver agreement calculated over a total of 63 participants for DISH status was κ=0.788 (95% CI=0.596-0.981). The weighted kappa coefficient for both aggreement was between 0.61-0.80, indicating that there was good agreement between the researchers and assessment results were consistent. In the second stage, 326 pelvic CT scans that met the inclusion criteria for pelvic evaluation were reviewed for pelvic enthesophyte burden in all 3 groups. Pelvic enthesophyte load score was higher in the early-stage and classic DISH groups compared to the no-DISH group (p<0.001). In addition, ankylosis and erosion of sacroiliac joints were observed in the early-stage and classic DISH groups, although not statistically significant. Afterwards, univariate analyses of demographic and clinical findings were compared between the groups. The coronary artery disease and diabetes mellitus was more frequent in the early-stage and classic DISH groups than in the no-DISH group (p<0.001). Hyperlipidemia was more frequent in the early-stage and classic DISH groups compared to the no-DISH group (p=0.001). Metabolic syndrome was more frequent in the early-stage and classic DISH groups compared to the no-DISH group (p=0.002). Hypertension was more frequent in the no-DISH group compared to the early-stage and classic DISH groups (p<0.001). Early-stage and classic DISH groups were older than the no-DISH group (p<0.001). Body mass index was higher in the early-stage and classic DISH groups compared to the no-DISH group (p<0.001). Fasting blood glucose levels were higher in the early-stage and classic DISH groups compared to the no-DISH group (p<0.001). There was no significant difference between the groups in terms of cancer frequency (p=0.333). We then created a model to identify risk factors for early-stage and classic DISH. In this analysis, classic DISH was 2.3 times more common in men than in women (95% CI: 1.044 - 5.162). Patients with hypertension were approximately 2.76 times more likely to have early-stage DISH (95% CI: 1.185 - 6.428). Patients aged 60-69 years were 2.45 times more likely to have early-stage DISH than those aged 18-59 years (95% CI: 1.061 - 5.663). Patients aged 70-79 years were 4.28 times more likely to have classic DISH than those aged 18-59 years (95% CI: 1.648 - 11.126). Patients aged 80-96 years were 6.25 times more likely to have classic DISH than those aged 18-59 years (95% CI: 1.485 - 26.259).