Which radiographic finding is associated with Diffuse Idiopathic Skeletal Hyperostosis (DISH) as a tortuous paravertebral mass anterior to the vertebral bodies?

• A. Syndesmophytes
• B. Osteophytes
• C. Calcifications of the intervertebral discs
• D. Erosions of the vertebral endplates

Answer: (A)

Diffuse Idiopathic Skeletal Hyperostosis shows flowing calcifications along the anterior longitudinal ligament (ALL) that span multiple contiguous vertebrae, producing a tortuous, anterior paravertebral mass. This radiographic pattern is best described as osteophyte-like ossification of the ALL, giving a continuous anterior “ribbon” of bone in front of the spine. It differs from syndesmophytes, which are vertical bridging ossifications typically seen in ankylosing spondylitis and involve the edges of the vertebral bodies rather than forming a broad anterior mass. The hallmark DISH features—flowing anterior ossifications with preserved disc height and without vertebral endplate erosions—help distinguish this finding as ALL ossification rather than intervertebral disc calcification or endplate erosions.