title: Correlations of Ventricular Enlargement with Rheologically Active Surfactant Proteins in Cerebrospinal Fluid.
abstract: Purpose: Surfactant proteins (SPs) are involved in the regulation of rheological properties of body fluids. Concentrations of SPs are altered in the cerebrospinal fluid (CSF) of hydrocephalus patients. The common hallmark of hydrocephalus is enlargement of the brain ventricles. The relationship of both phenomena has not yet been investigated. The aim of this study was to evaluate the association between SP concentrations in the CSF and enlargement of the brain ventricles.Procedures: Ninty-six individuals (41 healthy subjects and 55 hydrocephalus patients) were included in this retrospective analysis. CSF specimens were analyzed for SP-A, SP-B, SP-C and SP-D concentrations by use of enzyme linked immunosorbent assays (ELISA). Ventricular enlargement was quantified in T2 weighted (T2w) magnetic resonance imaging (MRI) sections using an uni-dimensional (Evans' Index) and a two-dimensional approach (lateral ventricles area index, LVAI).Results: CSF-SP concentrations (mean ± standard deviation in ng/ml) were as follows: SP-A 0.71 ± 0.58, SP-B 0.18 ± 0.43, SP-C 0.89 ± 0.77 and SP-D 7.4 ± 5.4. Calculated values of Evans' Index were 0.37 ± 0.11, a calculation of LVAI resulted in 0.18 ± 0.15 (each mean ± standard deviation). Significant correlations were identified for Evans' Index with SP-A (r= 0.388,p< 0.001) and SP-C (r= 0.392,p< 0.001), LVAI with SP-A (r= 0.352,p= 0.001), SP-C (r= 0.471,p< 0.001) and SP-D (r= 0.233,p= 0.025). Furthermore, SP-C showed a clear inverse correlation with age (r= -0.357,p= 0.011).Conclusion: The present study confirmed significant correlations between SPs A, C and D in the CSF with enlargement of the inner CSF spaces. In conclusion, SPs clearly play an important role for CSF rheology. CSF rheology is profoundly altered in hydrocephalic diseases, however, diagnosis and therapy of hydrocephalic conditions are still almost exclusively based on ventricular enlargement. Until now it was unclear, whether the stage of the disease, as represented by the extent of ventricular dilatation, is somehow related to the changes of SP levels in the CSF. Our study is the first to provide evidence that increasing ventriculomegaly is accompanied by enhanced changes of rheologically active compounds in the CSF and therefore introduces completely new aspects for hydrocephalus testing and conservative therapeutic approaches.
authors.affiliation: Department of Neuroradiology, Leipzig University Leipzig, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schob
authors.affiliation: Department of Neuroradiology, Leipzig University Leipzig, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weiß
authors.affiliation: Department of Ophthalmology, Leipzig University Leipzig, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Dieckow
authors.affiliation: Institute of Anatomy, Leipzig University Leipzig, Germany.
authors.forename: Cindy
authors.initials: C
authors.lastname: Richter
authors.affiliation: Department of Neurology, Leipzig University Leipzig, Germany.
authors.forename: Mandy
authors.initials: M
authors.lastname: Pirlich
authors.affiliation: Department of Neuroradiology, Leipzig University Leipzig, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Voigt
authors.affiliation: Department of Diagnostic and Interventional Radiology, Leipzig University Hospital Leipzig, Germany.
authors.forename: Alexey
authors.initials: A
authors.lastname: Surov
authors.affiliation: Department of Neuroradiology, Leipzig University Leipzig, Germany.
authors.forename: Karl-Titus
authors.initials: KT
authors.lastname: Hoffmann
authors.affiliation: Department of Neuroradiology, Leipzig University Leipzig, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Quaeschling
authors.affiliation: Department of Neurosurgery, Leipzig University Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Preuß
keywords: CSF; Evans’ index; MRI; surfactant proteins; ventricular enlargement