Diagnostic Values of β2-Transferrin and β-Trace Protein as Markers for Cerebrospinal Fluid Fistula

Abstract

Introduction: During recent decades, the diagnosis of CSF fistula has been investigated using β2-transferrin and β-trace protein (prostaglandin D synthase) as immunological diagnostic markers. A method for detecting CSF traces should be noninvasive, reliable, and cheap. Methods: The characteristics of the 2 immunological markers are described based on my own experience and a literature review. PubMed was searched, and 39 articles were found from the period 1987–2007. Results: The β2-transferrin marker showed a high reliability during the last decades using immunofixation or immunoblotting. The performance of the β2-transferrin assay requires between 2 and 4 hours hands-on time in the laboratory, depending on the assay. The β-trace protein marker showed a high reliability when assayed using immunoelectrophoresis or laser nephelometry. Laser nephelometry is automated; not time-consuming; provides quantitative results; and, last but not least, is cheap. A cutoff at 1.11 mg/L for β-trace protein gave the best trade-off between a high sensitivity and a high specificity when including the secretion-to-serum ratio. Conclusion: Both, the β2-transferrin and the β-trace protein are reliable immunological markers for the detection of CSF traces. High diagnostic values were found for both proteins.