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Published on: November 29, 2019
Elevated CSF Beta Trace Protein Levels in Patients with CSF-Venous Fistulas
Ian T Mark1, Parnian Habibi2, D K Kim2
1From the Department of Radiology (I.T.M., P.H., D.K.K., G.B.L., P.P.M., C.M.C., M.P.O., D.S., J.V., A.A.M., J.B., B.J.-T.,W.B.), Neurology (J.C.-G.), Laboratory medicine and Pathology (J.W.M.) and Quantitative Health Sciences (N.L., S.G.), Mayo Clinic, Rochester, MN. Mark.Ian@mayo.edu.
Background And Purpose:
Spontaneous Intracranial Hypotension continues to be an underdiagnosed and debilitating disease. One contributing factor of the diagnostic challenge is the lack of objective biomarkers. Beta trace protein (BTP) is the most abundantly CNS derived protein in the CSF. The purpose of this study was to evaluate CSF BTP levels in patients who underwent lateral decubitus myelography for CSF-venous fistula (CVF) workup and evaluate if BTP levels could differentiate those with positive and negative myelogram.
Materials And Methods:
71 patients who underwent lateral decubitus myelography were prospectively enrolled and had CSF measured for BTP. The myelogram results were evaluated by two independent neuroradiologists and classified as definite (2 positive reads), negative (2 negative reads), or indeterminate (any other combination). Continuous variables were described using means, standard deviations, medians, and ranges, and compared across groups using the Kruskal-Wallis test. To evaluate whether BTP levels were associated with myelogram results, a multinomial logistic regression model was fitted with myelogram result (Negative, Indeterminate, Definite) as the outcome.
Results:
Of the 71 patients, the mean age was 51.2 years (SD 15.4) and 44 patients were female (62%). 64 patients (90.1%) underwent DSM and 7 underwent photon counting detector-CT myelography. 22 patients (30.1%) were positive (mean BTP 34.4 mg/L, SD 8.7), 15 (21.1%) were indeterminate (mean BTP 21.2 mg/L, SD 7.9), and 34 (47.9%) were negative for CVF (mean BTP 16.8 mg/L (SD 5.2) (p < 0.0001). For each unit increase in BTP, there is 48% increase in odds of having a definite compared to negative myelogram result after adjusting for age and sex.
Conclusion:
Patients with CVF had twice the CSF BTP level compared to those with a negative myelogram. This suggests that CSF BTP levels could be used as a potential biomarker to identify patients with CVF.
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