Impact of the cerebrospinal fluid-mask algorithm on the diagnostic performance of 123I-Ioflupane SPECT: an investigation of parkinsonian syndromes

Background: Various cerebrospinal fluid (CSF) biomarkers are studied in Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS). Several studies found reduced 5-hydroxyindoleacetic acid (5-HIAA), the main serotonin metabolite, in PD. There is little evidence regarding its levels in APS. Methods: We measured 5-HIAA in the CSF of 90 PD patients, 16 MSA patients, 26 progressive supranuclear palsy (PSP) patients, 11 corticobasal degeneration (CBD) patients, and 31 controls. We also compared the values in depressed and non-depressed patients. Results: There was a statistically significant difference in CSF 5-HIAA in PD and MSA compared to the control group (median in PD 15.8 µg/l, in MSA 13.6 µg/l vs. 24.3 µg/l in controls; P=0.0008 in PD, P=0.006 in MSA). There was no statistically significant difference in CSF 5-HIAA in PSP and CBD compared to the control group (median in PSP 22.7 µg/l, in CBD 18.7 µg/l vs. 24.3 µg/l in controls; P= 1 in both PSP and CBD). CSF 5-HIAA levels were lower in PD patients with depression compared to PD patients without depression (median 8.34 vs. 18.48, P<0.0001). Conclusions: CSF 5-HIAA is decreased in PD and MSA. The CSF 5-HIAA levels in PSP and CBS did not differ from those of the control group. There was a tendency toward lower CSF 5-HIAA in MSA than in PD, however, the results did not reach statistical significance. These results may be explained by more severe damage of the serotonergic system in synucleinopathies (PD, MSA) than in tauopathies (PSP, CBS).

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Diagnostic performance of amplified Mycobacterium tuberculosis direct test with cerebrospinal fluid, other nonrespiratory, and respiratory specimens.

Journal of Clinical Microbiology ◽

10.1128/jcm.34.4.834-841.1996 ◽

1996 ◽

Vol 34 (4) ◽

pp. 834-841 ◽

Cited By ~ 78

Author(s):

G E Pfyffer ◽

P Kissling ◽

E M Jahn ◽

H M Welscher ◽

M Salfinger ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Mycobacterium Tuberculosis ◽

Diagnostic Performance ◽

Direct Test ◽

Respiratory Specimens

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Cerebrospinal fluid free kappa light chains and kappa index perform equal to oligoclonal bands in the diagnosis of multiple sclerosis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-0400 ◽

2018 ◽

Vol 57 (2) ◽

pp. 210-220 ◽

Cited By ~ 9

Author(s):

Mikael Christiansen ◽

Mikkel Carstensen Gjelstrup ◽

Morten Stilund ◽

Tove Christensen ◽

Thor Petersen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Oligoclonal Bands ◽

Light Chains ◽

Kappa Index ◽

Absolute Concentration ◽

Igg Index ◽

The Absolute

AbstractBackgroundDetection of intrathecal immunoglobulin G (IgG) synthesis by gold standard oligoclonal bands (OCB) or IgG index remains an integral part of multiple sclerosis (MS) diagnostics, although both methods have weaknesses. Emerging evidence suggests that automated detection of free light chains (FLC) in the cerebrospinal fluid (CSF) has diagnostic performance equal to OCB. The objective of this study was to compare the diagnostic performance of CSF FLC with OCB and IgG index in a large cohort of Scandinavian patients referred for MS evaluation.MethodsWe prospectively included 230 patients suspected for MS. They are composed of patients with MS (n=96), clinically isolated syndrome (n=37), other neurological diseases (OND, n=31) and symptomatic controls (SC, n=66). CSF and serum samples were analyzed for kappa and lambda FLC, OCB and IgG index. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis.ResultsBoth the absolute concentration of CSF-kappa and the kappa index had excellent MS diagnostic performances with ROC area under the curve of 0.93 and 0.94 (MS vs. SC+OND). At the 0.42 mg/L cutoff, CSF-kappa had sensitivity and specificity of 93.8% and 85.6%, whereas sensitivity and specificity for OCB was 82.3% and 93.8% (72.9% and 95.9% for IgG index at cutoff 0.64). CSF-lambda and lambda index performed inferior to CSF-kappa and kappa index.ConclusionsCSF-kappa and kappa index represent automated, rapid and low-cost alternatives to OCB. Using merely the absolute concentration of CSF-kappa is a logistic advantage in the clinical laboratories.

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P3-082: Multiplex analysis of Alzheimer-associated amyloid-β isoforms in cerebrospinal fluid - diagnostic performance in a case-control setting

Alzheimer s & Dementia ◽

10.1016/j.jalz.2008.05.1646 ◽

2008 ◽

Vol 4 ◽

pp. T541-T542

Author(s):

Annika Lekman ◽

Ulf Andreasson ◽

Monica Christiansson ◽

Åsa Källén ◽

Harald Hampel ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Diagnostic Performance ◽

Amyloid Β ◽

Case Control ◽

Multiplex Analysis ◽

Control Setting

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Diagnostic Performance of Galactomannan Antigen Testing in Cerebrospinal Fluid

Journal of Clinical Microbiology ◽

10.1128/jcm.02913-15 ◽

2015 ◽

Vol 54 (2) ◽

pp. 428-431 ◽

Cited By ~ 36

Author(s):

G. M. Chong ◽

J. A. Maertens ◽

K. Lagrou ◽

G. J. Driessen ◽

J. J. Cornelissen ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Diagnostic Performance ◽

European Organization ◽

Predictive Values ◽

Gm Csf ◽

Referral Hospitals ◽

Study Population ◽

Cerebral Biopsy ◽

Sensitivity Specificity ◽

Antigen Testing

Testing cerebrospinal fluid (CSF) for the presence of galactomannan (GM) antigen may help in diagnosing cerebral aspergillosis (CA). However, the use of the CSF GM test as a diagnostic test has been little studied. We evaluated its diagnostic performance by comparing the CSF GM optical density indexes (ODI) at different cutoffs in patients with probable and proven CA to those in patients without CA. Patients from 2 tertiary referral hospitals with suspected CA between 2004 and 2014 and in whom CSF GM ODI had been determined were selected. European Organization for Research and Treatment of Cancer/Invasive Infectious Diseases Study Mycoses Group (EORTC/MSG) definitions of invasive aspergillosis and CA were used, but with the exclusion of the test to be validated (i.e., the CSF GM test) as a microbiological EORTC/MSG criterion. The study population consisted of 44 patients (4 with proven CA, 13 with probable CA, and 27 with no CA). Of the 17 patients with CA, 15 had a CSF GM ODI of ≥2.0. Of 27 patients without CA, 26 had a CSF GM ODI of <0.5 and 1 had a CSF GM ODI of 8.2. When a GM CSF ODI cutoff of 1.0 was used, the sensitivity, specificity, and positive and negative predictive values were 88.2%, 96.3%, 93.8%, and 92.9%, respectively. The same results were found when a CSF GM ODI cutoff of 0.5 or 2.0 was used. Testing GM in CSF has a high diagnostic performance for diagnosing CA and may be useful to diagnose or virtually rule out the infection without the need for a cerebral biopsy.

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Diagnostic Performance of an Aspergillus-Specific Nested PCR Assay in Cerebrospinal Fluid Samples of Immunocompromised Patients for Detection of Central Nervous System Aspergillosis

PLoS ONE ◽

10.1371/journal.pone.0056706 ◽

2013 ◽

Vol 8 (2) ◽

pp. e56706 ◽

Cited By ~ 49

Author(s):

Mark Reinwald ◽

Dieter Buchheidt ◽

Margit Hummel ◽

Matthias Duerken ◽

Hartmut Bertz ◽

...

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Nested Pcr ◽

Diagnostic Performance ◽

Immunocompromised Patients ◽

Pcr Assay

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A panel of nine cerebrospinal fluid biomarkers may identify patients with atypical parkinsonian syndromes

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2014-309562 ◽

2015 ◽

Vol 86 (11) ◽

pp. 1240-1247 ◽

Cited By ~ 116

Author(s):

N K Magdalinou ◽

R W Paterson ◽

J M Schott ◽

N C Fox ◽

C Mummery ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Amyloid Precursor Protein ◽

Area Under The Curve ◽

Precursor Protein ◽

Csf Biomarkers ◽

Neurofilament Light Chain ◽

Neurofilament Light ◽

Monocyte Chemoattractant Protein 1 ◽

Parkinsonian Syndromes ◽

Healthy Elderly

BackgroundPatients presenting with parkinsonian syndromes share many clinical features, which can make diagnosis difficult. This is important as atypical parkinsonian syndromes (APSs) such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal syndrome (CBS) carry a poor prognosis, compared with patients with Parkinson's disease (PD). In addition, there is overlap between APS and dementia diseases, such as Alzheimer's disease (AD) and frontotemporal dementia (FTD).ObjectiveTo use a panel of cerebrospinal fluid (CSF) biomarkers to differentiate patients with APS from PD and dementia.MethodsA prospective cohort of 160 patients and 30 control participants were recruited from a single specialist centre. Patients were clinically diagnosed according to current consensus criteria. CSF samples were obtained from patients with clinical diagnoses of PD (n=31), PSP (n=33), CBS (n=14), MSA (n=31), AD (n=26) and FTD (n=16). Healthy, elderly participants (n=30) were included as controls. Total τ (t-τ), phosphorylated τ (p-τ), β-amyloid 1–42 (Aβ42), neurofilament light chain (NFL), α-synuclein (α-syn), amyloid precursor protein soluble metabolites α and β (soluble amyloid precursor protein (sAPP)α, sAPPβ) and two neuroinflammatory markers (monocyte chemoattractant protein-1 and YKL-40) were measured in CSF. A reverse stepwise regression analysis and the false discovery rate procedure were used.ResultsCSF NFL (p<0.001), sAPPα (p<0.001) and a-syn (p=0.003) independently predicted diagnosis of PD versus APS. Together, these nine biomarkers could differentiate patients with PD from APS with an area under the curve of 0.95 and subtypes of APS from one another. There was good discriminatory power between parkinsonian groups, dementia disorders and healthy controls.ConclusionsA panel of nine CSF biomarkers was able to differentiate APS from patients with PD and dementia. This may have important clinical utility in improving diagnostic accuracy, allowing better prognostication and earlier access to potential disease-modifying therapies.

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