Beta-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula.
OBJECTIVE
Cerebrospinal fluid (CSF) fistulas need to be reliably diagnosed for the optimal management. Recently, in preference to beta2-transferrin, another CSF protein, beta-trace protein (betaTP), is similarly used with a new method for CSF diagnosis. This study evaluates the sensitive interpretation and limits of this new betaTP test for use in routine CSF fistula diagnosis.


METHODS
Nephelometric detection of betaTP has been made in nasal secretion, serum, and CSF samples from healthy individuals as well as patients with reduced glomerular filtration rate and with bacterial meningitis. Additionally, 53 patients with suspected CSF rhinorrhea are also analyzed.


RESULTS
The betaTP test can also be used to reliably diagnose CSF rhinorrhea even slightly better than the beta2-transferrin test. It should not be used for patients with renal insufficiency and bacterial meningitis as they substantially increase serum and decrease CSF betaTP values, respectively.


CONCLUSIONS
Quantitative measurement of betaTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with beta2-transferrin test or sodium-fluorescein test.
Salzburg University Medical School, Department of Otolaryngology-Head and Neck Surgery, Müllner Hauptstr 48, A-5020, Salzburg, Austria. c.meco@lks.at
Cem
C
Meco
Gerhard
G
Oberascher
Erich
E
Arrer
Gerhard
G
Moser
Klaus
K
Albegger
D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000276:immunology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D003404:Creatinine / Q000097:blood; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D017408:Guidelines as Topic; D006801:Humans; D019746:Intramolecular Oxidoreductases / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology*; D054834:Lipocalins; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000276:immunology / Q000378:metabolism; D009391:Nephelometry and Turbidimetry / Q000295:instrumentation*; D011137:Polystyrenes / Q000276:immunology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019291:Skull Base / Q000000981:diagnostic imaging; D012887:Skull Fractures / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000906:Antibodies; D054834:Lipocalins; D011137:Polystyrenes; D003404:Creatinine; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase