How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula
This report describes the sensitivity and specificity of glucose detection using Glucostix test strips and computed tomography (CT) of the skull base for confirming cerebrospinal fluid (CSF) fistulae in patients with persistent rhinorrhoea or otorrhoea, and comparing them with the beta-2 transferrin...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2004-01-01
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| Series: | Asian Journal of Surgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958409602426 |
| _version_ | 1818049963288952832 |
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| author | Danny T.M. Chan Wai Sang Poon Chui Ping Ip Philip W.Y. Chiu Keith Y.C. Goh |
| author_facet | Danny T.M. Chan Wai Sang Poon Chui Ping Ip Philip W.Y. Chiu Keith Y.C. Goh |
| author_sort | Danny T.M. Chan |
| collection | DOAJ |
| description | This report describes the sensitivity and specificity of glucose detection using Glucostix test strips and computed tomography (CT) of the skull base for confirming cerebrospinal fluid (CSF) fistulae in patients with persistent rhinorrhoea or otorrhoea, and comparing them with the beta-2 transferrin assay as the gold standard for CSF detection.
Methods: Fluid samples from the nose were collected from 18 patients with suspected CSF fistulae. The samples were assayed for beta-2 transferrin using the Western blotting and immunostaining technique. CT (5 mm axial slice) of the skull base was performed for evidence of skull base fracture. The glucose levels and Glucostix results were compared.
Results: Out of the 18 samples, 15 were positive for beta-2 transferrin and the leaks were validated surgically in 10 patients. Five leaks healed spontaneously with conservative management. Glucostix tests produced three false positive results from blood and nasal mucus contaminated fluid. Glucostix failed to detect another three CSF leaks resulting from false negative tests because of low CSF glucose levels. The Glucostix glucose test was non-specific and insensitive compared with the beta-2 transferrin assay. CT failed to detect three out of the 15 beta-2 transferrin-positive leaks but there were no false positive results. CT produced six negative results, of which three were false negatives.
Conclusions: Glucose detection using Glucostix test strips is not recommended as a confirmatory test due to its lack of specificity and sensitivity. In the presence of a skull base fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. |
| first_indexed | 2024-12-10T10:45:55Z |
| format | Article |
| id | doaj.art-0f473b6d9eb34301840c089e69647745 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-12-10T10:45:55Z |
| publishDate | 2004-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-0f473b6d9eb34301840c089e696477452022-12-22T01:52:10ZengElsevierAsian Journal of Surgery1015-95842004-01-01271394210.1016/S1015-9584(09)60242-6How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid FistulaDanny T.M. ChanWai Sang PoonChui Ping IpPhilip W.Y. ChiuKeith Y.C. GohThis report describes the sensitivity and specificity of glucose detection using Glucostix test strips and computed tomography (CT) of the skull base for confirming cerebrospinal fluid (CSF) fistulae in patients with persistent rhinorrhoea or otorrhoea, and comparing them with the beta-2 transferrin assay as the gold standard for CSF detection. Methods: Fluid samples from the nose were collected from 18 patients with suspected CSF fistulae. The samples were assayed for beta-2 transferrin using the Western blotting and immunostaining technique. CT (5 mm axial slice) of the skull base was performed for evidence of skull base fracture. The glucose levels and Glucostix results were compared. Results: Out of the 18 samples, 15 were positive for beta-2 transferrin and the leaks were validated surgically in 10 patients. Five leaks healed spontaneously with conservative management. Glucostix tests produced three false positive results from blood and nasal mucus contaminated fluid. Glucostix failed to detect another three CSF leaks resulting from false negative tests because of low CSF glucose levels. The Glucostix glucose test was non-specific and insensitive compared with the beta-2 transferrin assay. CT failed to detect three out of the 15 beta-2 transferrin-positive leaks but there were no false positive results. CT produced six negative results, of which three were false negatives. Conclusions: Glucose detection using Glucostix test strips is not recommended as a confirmatory test due to its lack of specificity and sensitivity. In the presence of a skull base fracture on CT and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity.http://www.sciencedirect.com/science/article/pii/S1015958409602426 |
| spellingShingle | Danny T.M. Chan Wai Sang Poon Chui Ping Ip Philip W.Y. Chiu Keith Y.C. Goh How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula Asian Journal of Surgery |
| title | How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula |
| title_full | How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula |
| title_fullStr | How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula |
| title_full_unstemmed | How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula |
| title_short | How Useful is Glucose Detection in Diagnosing Cerebrospinal Fluid Leak? The Rational Use of CT and Beta-2 Transferrin Assay in Detection of Cerebrospinal Fluid Fistula |
| title_sort | how useful is glucose detection in diagnosing cerebrospinal fluid leak the rational use of ct and beta 2 transferrin assay in detection of cerebrospinal fluid fistula |
| url | http://www.sciencedirect.com/science/article/pii/S1015958409602426 |
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