Differentiating between degenerative disc disease (DDD), diffuse idiopathic skeletal hyperostosis (DISH), and axial spondyloarthritis (axSpA) represents a diagnostic challenge in patients with low back pain (LBP). We aimed to evaluate the distribution of inflammatory and degenerative imaging features in a real-life cohort of LBP patients referred to a tertiary university rheumatology center. In a retrospective cross-sectional analysis of patients referred for LBP, demographics, symptom information, and available imaging were collected. SpA-like changes were considered in the spine in the presence of one of the following lesions typically related to SpA: erosions, sclerosis, squaring, and syndesmophytes on conventional radiographs (CR) and bone marrow oedema (BMO), erosions, sclerosis, and fat lesions (FL) on MRI. SIJ CR were graded per New York criteria; on MRIs, SIJs were evaluated by quadrant for BMO, erosions, FL, sclerosis and ankylosis, similar to the approach used by the Berlin SIJ MRI scoring system. The final diagnosis made by the rheumatologist was the gold standard. Data were presented descriptively, by patient and by quadrant, and compared among the three diagnosis groups. Among 136 referred patients, 71 had DDD, 38 DISH, and 27 axSpA; median age 62 years [IQR55-73], 63% males. On CR, SpA-like changes were significantly higher in axSpA in the lumbar (50%, vs. DDD 23%, DISH 22%), in DISH in the thoracic (28%, vs. DDD 8%, axSpA 12%), and in DDD in the cervical spine (67% vs. DISH 0%, axSpA 33%). On MRI, BMO was significantly higher in DISH in the thoracic (37%, vs. DDD 22%, axSpA 5%) and equally distributed in the lumbar spine (35-42%). FL were significantly more frequently identified in DISH and axSpA in the thoracic (56% and 52%) and DDD and axSpA in the lumbar spine (65% and 74%, respectively). Degenerative changes were frequent in the three groups. Sacroiliitis (NY criteria) was identified in 49% (axSpA 76%, DDD 48%, DISH 29%). A significant overlap was found among DDD, DISH, and axSpA for inflammatory and degenerative imaging features. Particularly, SpA-like spine CR features were found in one-fourth of patients with DISH, and MRI BMO was found in one-third of those patients.

中文翻译：

---

退行性椎间盘疾病、弥漫性特发性骨骼肥厚和中轴型脊柱关节炎患者的影像学炎症和退行性特征显着重叠：一项现实生活中的队列研究


区分退行性椎间盘疾病 (DDD)、弥漫性特发性骨骼肥厚 (DISH) 和中轴型脊柱关节炎 (axSpA) 是腰痛 (LBP) 患者的诊断挑战。我们的目的是评估现实生活中转诊至三级大学风湿病中心的 LBP 患者队列中炎症和退行性影像学特征的分布。在对转诊腰痛患者的回顾性横断面分析中，收集了人口统计数据、症状信息和可用的影像学信息。如果存在以下通常与 SpA 相关的病变之一，则认为脊柱存在 SpA 样变化：常规 X 光片 (CR) 和骨髓水肿 (BMO) 上的糜烂、硬化、成方形和韧带骨赘、糜烂、硬化和骨赘。 MRI 上的脂肪病变 (FL)。 SIJ CR 根据纽约标准进行评分；在 MRI 上，SIJ 按 BMO、糜烂、FL、硬化和强直象限进行评估，类似于柏林 SIJ MRI 评分系统使用的方法。风湿病专家做出的最终诊断是金标准。数据按患者和象限进行描述性呈现，并在三个诊断组之间进行比较。在 136 名转诊患者中，71 名患有 DDD，38 名患有 DISH，27 名患有 axSpA；中位年龄 62 岁 [IQR55-73]，63% 为男性。 CR 时，腰椎 axSpA 中的 SpA 样变化显着较高（50%，对比 DDD 23%，DISH 22%），胸椎 DISH 中（28%，对比 DDD 8%，axSpA 12%），颈椎 DDD（67% vs. DISH 0%，axSpA 33%）。 MRI 上显示，胸椎 DISH 中 BMO 显着较高（37%，DDD 22%，axSpA 5%），腰椎分布均匀（35-42%）。 胸椎 DISH 和 axSpA（分别为 56% 和 52%）以及腰椎 DDD 和 axSpA（分别为 65% 和 74%）中发现 FL 的频率明显更高。三组中退行性变化很频繁。 49% 的患者发现骶髂关节炎（NY 标准）（axSpA 76%、DDD 48%、DISH 29%）。在 DDD、DISH 和 axSpA 之间发现炎症和退行性成像特征显着重叠。特别是，四分之一的 DISH 患者发现了类似 SpA 的脊柱 CR 特征，三分之一的患者发现了 MRI BMO。