By Richard Dargan
Routine CT detects a musculoskeletal condition linked with untreated metabolic syndrome, potentially speeding interventions and treatment, according to research presented Wednesday.
Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition in which ligaments and tendons harden and calcify, especially where they attach to the spine. It leads to decreased mobility, respiratory complications and a predisposition to unstable spinal fractures and affects approximately 14% of people in the United States.
There is significant crossover between DISH and metabolic syndrome, a group of conditions like excess abdominal weight and high blood sugar that increase the risk of cardiovascular disease, diabetes and stroke.
Researchers at Vanderbilt University Medical Center (VUMC) in Nashville, TN, investigated DISH as a potential opportunistic radiologic marker for untreated metabolic syndrome. The study group consisted of 599 treatment-naïve patients aged 40 to 65 without a history of cancer or fracture. The patients had complete metabolic data within 90 days of a thoracolumbar CT.
Among the 599 patients, 139 (23.2%) had DISH. Metabolic syndrome was found in 56.1% of patients with DISH, compared with only 30% in those without DISH. In a statistical model adjusting for age and sex, body mass index and HbA1c, a measure of blood sugar, were independently linked with DISH.
“Our results show that DISH is associated with metabolic syndrome, especially obesity and poor glycemic control,” said co-presenter and study coauthor Lily Gao, fourth-year medical student at Vanderbilt. “That strongly suggests that DISH may be an imaging marker for elevated cardiometabolic risk.”
“Radiologists should consider reporting DISH in the impression, as an actionable point that can guide further management. This kind of opportunistic screening increases the value of an imaging study and allows radiologists to contribute directly to preventive health.”
Lily Gao
Radiology reports note the presence of DISH but do not discuss its implications, a limitation that could lead to missed opportunities for detecting and treating patients with metabolic syndrome.
“Radiologists should consider reporting DISH in the impression as an actionable point that can guide further management,” said Gao. “This kind of opportunistic screening increases the value of an imaging study and allows radiologists to contribute directly to preventive health.”
Co-presenter and study coauthor Kate Jordan, MD, a second-year resident at Vanderbilt who is in her emergency department (ED) rotation, echoed that sentiment, noting the number of people who receive CT for abdominal pain in the ED.
“DISH status is a good flag for us to raise for patients who may not have regular checkups,” Dr. Jordan said. “It gives us a chance to recommend some things that they can do address their condition with some follow-up evaluation.”
Key to the study was a DISH scoring system developed by Gao and colleagues that better assesses the degree of ossification over the whole spine.
Under the direction of study senior author Katherine D. Van Schaik, MD PhD, MA, assistant professor of radiology and radiological sciences at VUMC and of classical and mediterranean studies and electrical and computer engineering at Vanderbilt University, the researchers recently applied the scoring system to CT scans of Peruvian and Egyptian mummies. They found very low rates of DISH in the mummies, likely due to more active lifestyles.
Access the session, “DISH-Covery: Opportunistic Detection of Cardiometabolic Risk on Routine CT,” (W5-STCE2-1) on demand at RSNA.org/MeetingCentral.
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The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
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