Rheumatology International

, Volume 35, Issue 3, pp 493–497 | Cite as

Ultrasonography of peripheral entheses in the diagnosis and understanding of diffuse idiopathic skeletal hyperostosis (DISH)

  • Reuven Mader
  • Irina Novofastovski
  • Salvatore Iervolino
  • Alex Pavlov
  • Leonid Chervinsky
  • Naama Schwartz
  • Nicola Pappone
Original Article - Imaging


The aim of this study was to investigate musculoskeletal ultrasound (MSUS) as a diagnostic modality in DISH and to explore whether it might help in elucidating its pathogenesis and events that precede the calcification/ossification process. Fifty patients with DISH and 34 patients with osteoarthritis of the lower limbs without DISH were investigated. Data regarding demographics and traditional cardiovascular risk factors were collected from all patients. An ultrasonography was performed according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS) by observers who were blinded to the diagnosis or the clinical findings in the patients. The total mean GUESS score for patients with DISH was 14.12 ± 5.2 and for patients without DISH 5.32 ± 4.99 (P < 0.0001). Univariate logistic regression analysis found a strong association between the GUESS and the probability of having DISH (P < 0.0001). The area under the ROC curve (AUC) revealed that the GUESS accuracy in diagnosing DISH was 88.53 % with sensitivity and specificity of 92 and 70.6 %, respectively, at a cutoff value of 6.36. A stepwise logistic regression analysis of the statistically significant items in the GUESS isolated four items, and the presence of either all of them or the first three items yielded the likelihood of having DISH to be 98.8 and 90.6 %, respectively. The GUESS and the stepwise logistic regression analysis of the GUESS items demonstrated a high likelihood of having DISH. MSUS might help to identify entheseal changes in DISH. Further studies are needed to confirm these results.


DISH Enthesopathy Ultrasonography 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Reuven Mader
    • 1
    • 2
  • Irina Novofastovski
    • 1
  • Salvatore Iervolino
    • 3
  • Alex Pavlov
    • 4
  • Leonid Chervinsky
    • 4
  • Naama Schwartz
    • 5
  • Nicola Pappone
    • 3
  1. 1.Rheumatic Diseases UnitHa’Emek Medical CenterAfulaIsrael
  2. 2.The B. Rappaport Faculty of MedicineThe Technion Institute of TechnologyHaifaIsrael
  3. 3.Rheumatology and Rehabilitation Research Unit, “Salvatore Maugeri” FoundationIRCCS Scientific InstituteTelese TermeItaly
  4. 4.Department of RadiologyHa’Emek Medical CenterAfulaIsrael
  5. 5. BiostatisticsHa’Emek Medical CenterAfulaIsrael

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