Whole Spine and Sacroiliac Joint MRI of Patients With and Without Metabolic Syndrome: A Preliminary Study

Sep 30, 2026

Background: Spine MRI findings in Diffuse Idiopathic Skeletal Hyperostosis (DISH) include inflammation-related lesions such as bone marrow edema (BME) and fatty corner lesions, which are known to associate with metabolic syndrome (MeS). Objective: Characterize spine and sacroiliac MRI lesions in patients with MeS. Methods: A small preliminary cross-sectional case–control study compared patients with and without MeS (age 40–50), excluding DISH by chest radiography or CT. Whole-spine and sacroiliac MRI were scored for BME, fat lesions, sclerosis, ankylosis, erosions, enthesitis, and capsulitis, with inflammatory and structural scores calculated. Results: Twenty-four patients were included; MeS patients had significantly more total lesions, higher fat scores, and higher structural scores. Each MeS component correlated with higher MRI lesion scores. Conclusions: MeS is associated with significantly higher spinal and sacroiliac inflammatory and structural MRI scores even without radiographic/CT evidence of DISH.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

1. Introduction

DISH, metabolic syndrome, and imaging rationale

MRI lesion types and differences from axSpA

Evidence gaps and study aim

2. Materials and Methods

Study design and inclusion criteria

MRI acquisition and lesion scoring

Article Whole Spine and Sacroiliac Joint MRI of Patients With and Without Metabolic Syndrome: A Preliminary Study Amir Bieber 1,2, *, Shay Brikman 1,2, Mohamad Nujeidat 3, Irina Novofasovsky 2, Reuven Mader 2,† and Iris Eshed 4,5 Academic Editor: Fabiano Bini Received: 21 November 2025 Revised: 14 December 2025 Accepted: 23 December 2025 Published: 29 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3109601, Israel; [shay.brikman@technion.ac.il](shay.brikman@technion.ac.il) 2 Rheumatic Diseases Unit, Emek Medical Center, Afula 18101, Israel; [irina_no@clalit.org.il](irina_no@clalit.org.il) (I.N.) 3 Department of Internal Medicine C, Emek Medical Center, Afula 1834111, Israel; [nujeidatmohamad@gmail.com](nujeidatmohamad@gmail.com) 4 Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 5262160, Israel; [iriseshed@gmail.com](iriseshed@gmail.com) 5 The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 69978, Israel * Correspondence: [amir.bieber@technion.ac.il](amir.bieber@technion.ac.il); Tel.: +972-4-6494354; Fax: +972-4-6494453 † Deceased author. Abstract Background: MRIs of spine Diffuse Idiopathic Skeletal Hyperostosis (DISH) demonstrate inflammation-related lesions such as bone marrow edema (BME) and fatty lesions in vertebral corners. DISH is known to be associated with metabolic syndrome (MeS) . Spinal MRI lesions in patients with metabolic syndrome (MeS) alone were not described. Aim: To characterize spine and sacroiliac MRI lesions among patients with MeS. Methods: This study is a small preliminary cross-sectional case–control study. Study groups were defined as patients with and without MeS. All patients were between 40 and 50 years of age and did not have DISH by chest radiography or CT. All patients underwent whole-spine and sacroiliac joint MRI. MRI was scored by a radiologist blinded to the patient’s clinical data for the presence of BME, fat lesion, sclerosis, ankylosis, erosions, enthesitis, and capsulitis. Groups were compared for the prevalence of each lesion, and scores were calculated for inflammatory and structural scores. Clinical data regarding MeS was also collected. Results: Twenty-four patients were included (twelve male; mean age: 45 years at imaging); fifteen with and nine without MeS. Patients in the MeS study group had significantly more MRI lesions, reflected as a higher total sum lesion score (p = 0.013), a higher fat lesion score (p = 0.013), and a higher total structural lesion score (p = 0.014) . Also, each of the MeS components was significantly associated with higher MRI scores. Conclusions: Significantly higher spinal and sacroiliac scores of both inflammatory-and structuralrelated lesions were present on MRI of MeS patients compared to patients without MeS. Keywords: DISH; MRI; metabolic syndrome 1. Introduction Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a hyperostotic syndrome first described in the mid-20th century [1] . It is characterized by gross calcification and ossification, mostly of the thoracic spine [2] . The association between DISH and metabolic syndrome (MeS) is well known [3] . Several factors associated with MeS are specifically associated with DISH, mainly obesity, type 2 diabetes mellitus (DM), and cardiovascular atherosclerotic morbidity [4–8] . While DISH represents a relatively end-stage of axial ossification, preDISH states have been described, mostly using chest radiography or computed tomography (CT) [9,10] . However, there are currently no studies that specifically address the pre-DISH state and MeS on MRI. Both DISH and axial spondyloarthritis (axSpA) are enthesis-related bone-forming conditions that in their end stage may lead to spi

FAQs

What was the study’s main objective?

To characterize spine and sacroiliac MRI lesions among patients with metabolic syndrome (MeS).

How were participants selected and what imaging was used to exclude DISH?

Participants were 40–50 years old and had no DISH on chest radiography or CT; whole-spine and sacroiliac joint MRI were then performed.

Which MRI lesion categories were scored in this research?

BME, fat lesions, sclerosis, ankylosis, erosions, enthesitis, and capsulitis, followed by inflammatory and structural scoring.

Sep 30, 2026

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