J Korean Neurosurg Soc.  2015 Apr;57(4):235-241. 10.3340/jkns.2015.57.4.235.

Correlation of the Beta-Trace Protein and Inflammatory Cytokines with Magnetic Resonance Imaging in Chronic Subdural Hematomas : A Prospective Study

• Park KS
• Park SH
• Hwang SK
• Kim C
• Hwang JH

• KMID: 1956420
• DOI: http://doi.org/10.3340/jkns.2015.57.4.235

Abstract

OBJECTIVE
Magnetic resonance imaging (MRI) of chronic subdural hematoma (CSDH) detects various patterns, which can be attributed to many factors. The purpose of this study was to measure the level of interleukin-6 (IL-6), interleukin-8 (IL-8), and highly specific protein [beta-trace protein (betaTP)] for cerebrospinal fluid (CSF) in CSDHs, and correlate the levels of these markers with the MRI findings.
METHODS
Thirty one patients, treated surgically for CSDH, were divided on the basis of MRI findings into hyperintense and non-hyperintense groups. The concentrations of IL-6, IL-8, and betaTP in the subdural fluid and serum were measured. The betaTP was considered to indicate an admixture of CSF to the subdural fluid if betaTP in the subdural fluid (betaTP(SF))/betaTP in the serum (betaTP(SER))>2.
RESULTS
The mean concentrations of IL-6 and IL-8 of the hyperintense group (n=17) of T1-WI MRI were 3975.1+/-1040.8 pg/mL and 6873.2+/-6365.4 pg/mL, whereas them of the non-hyperintense group (n=14) were 2173.5+/-1042.1 pg/mL and 2851.2+/-6267.5 pg/mL (p<0.001 and p=0.004). The mean concentrations of betaTP(SF) and the ratio of betaTP(SF)/betaTP(SER) of the hyperintense group (n=13) of T2-WI MRI were 7.3+/-2.9 mg/L and 12.6+/-5.4, whereas them of the non-hyperintense group (n=18) were 4.3+/-2.3 mg/L and 7.5+/-3.9 (p=0.011 and p=0.011).
CONCLUSION
The hyperintense group on T1-WI MRI of CSDHs exhibited higher concentrations of IL-6 and IL-8 than non-hyperintense group. And, the hyperintese group on T2-WI MRI exhibited higher concentrations of betaTP(SF) and the ratio of betaTP(SF)/betaTP(SER) than non-hyperintense group. These findings appear to be associated with rebleeding and CSF admixture in the CSDHs.

Keyword

Chronic subdural hematoma; Interleukin; Beta-trace protein; Magnetic resonance imaging

MeSH Terms

Cerebrospinal Fluid
Cytokines*
Hematoma, Subdural, Chronic*
Humans
Interleukin-6
Interleukin-8
Interleukins
Magnetic Resonance Imaging*
Prospective Studies*
Cytokines
Interleukin-6
Interleukin-8
Interleukins

Figure

• 

  Fig. 1 Axial computed tomography scans revealing a homogenous group, with high density (A), isodensity (B), and low density types (C) and a heterogenous group, with the layering (D) and mixed density types (E).

• 

  Fig. 2 Axial T2-weighted magnetic resonance imaging showing a hyperintense group, with homogenous (A) and mixed types (B) and a non-hyperintense group, with isointense (C) and hypointense types (D).

Reference

1. Bachmann G, Petereit H, Djenabi U, Michel O. Predictive values of beta-trace protein (prostaglandin D synthase) by use of laser-nephelometry assay for the identification of cerebrospinal fluid. Neurosurgery. 2002; 50:571–576. discussion 576-577. PMID: 11841726.

2. Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma : results of a large single-center cohort study. Neurosurg Rev. 2004; 27:263–266. PMID: 15148652.

3. Bradley WG Jr, Schmidt PG. Effect of methemoglobin formation on the MR appearance of subarachnoid hemorrhage. Radiology. 1985; 156:99–103. PMID: 4001427.

4. Fobben ES, Grossman RI, Atlas SW, Hackney DB, Goldberg HI, Zimmerman RA, et al. MR characteristics of subdural hematomas and hygromas at 1.5 T. AJR Am J Roentgenol. 1989; 153:589–595. PMID: 2763959.

5. Frati A, Salvati M, Mainiero F, Ippoliti F, Rocchi G, Raco A, et al. Inflammation markers and risk factors for recurrence in 35 patients with a posttraumatic chronic subdural hematoma : a prospective study. J Neurosurg. 2004; 100:24–32. PMID: 14743908.

6. Fujisawa H, Nomura S, Tsuchida E, Ito H. Serum protein exudation in chronic subdural haematomas : a mechanism for haematoma enlargement? Acta Neurochir. 1998; 140(Wien):161–165. discussion 165-166. PMID: 10398995.

7. Gomori JM, Grossman RI. Mechanisms responsible for the MR appearance and evolution of intracranial hemorrhage. Radiographics. 1988; 8:427–440. PMID: 3380989.

8. Gomori JM, Grossman RI, Hackney DB, Goldberg HI, Zimmerman RA, Bilaniuk LT. Variable appearances of subacute intracranial hematomas on high-field spin-echo MR. AJR Am J Roentgenol. 1988; 150:171–178. PMID: 3257117.

9. Hirashima Y, Endo S, Hayashi N, Karasawa K, Nojima S, Takaku A. Platelet-activating factor (PAF) and the formation of chronic subdural haematoma. Measurement of plasma PAF levels and anti-PAF immunoglobulin titers. Acta Neurochir (Wien). 1995; 137:15–18. PMID: 8748861.

10. Hong HJ, Kim YJ, Yi HJ, Ko Y, Oh SJ, Kim JM. Role of angiogenic growth factors and inflammatory cytokine on recurrence of chronic subdural hematoma. Surg Neurol. 2009; 71:161–165. discussion 165-166. PMID: 18423527.

11. Hosoda K, Tamaki N, Masumura M, Matsumoto S, Maeda F. Magnetic resonance images of chronic subdural hematomas. J Neurosurg. 1987; 67:677–683. PMID: 3668635.

12. Kitazono M, Yokota H, Satoh H, Onda H, Matsumoto G, Fuse A, et al. Measurement of inflammatory cytokines and thrombomodulin in chronic subdural hematoma. Neurol Med Chir (Tokyo). 2012; 52:810–815. PMID: 23183075.

13. Kleine TO, Damm T, Althaus H. Quantification of beta-trace protein and detection of transferrin isoforms in mixtures of cerebrospinal fluid and blood serum as models of rhinorrhea and otorrhea diagnosis. Fresenius J Anal Chem. 2000; 366:382–386. PMID: 11220324.

14. Koch AE, Polverini PJ, Kunkel SL, Harlow LA, DiPietro LA, Elner VM, et al. Interleukin-8 as a macrophage-derived mediator of angiogenesis. Science. 1992; 258:1798–1801. PMID: 1281554.

15. König SA, Schick U, Döhnert J, Goldammer A, Vitzthum HE. Coagulopathy and outcome in patients with chronic subdural haematoma. Acta Neurol Scand. 2003; 107:110–116. PMID: 12580860.

16. Krauss JK, Weigel R. Medical and surgical management of chronic subdural hematomas. In : Youmans JR, Winn R, editors. Youmans Neurological Surgery. ed 6. Philadelphia: Elsevier Saunders;2011. p. 535–543.

17. Kristof RA, Grimm JM, Stoffel-Wagner B. Cerebrospinal fluid leakage into the subdural space : possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma. J Neurosurg. 2008; 108:275–280. PMID: 18240922.

18. Lee KS. The pathogenesis and clinical significance of traumatic subdural hygroma. Brain Inj. 1998; 12:595–603. PMID: 9653522.

19. Lim DJ, Chung YG, Park YK, Song JH, Lee HK, Lee KC, et al. Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma. J Korean Med Sci. 1995; 10:373–378. PMID: 8750064.

20. Markwalder TM. Chronic subdural hematomas : a review. J Neurosurg. 1981; 54:637–645. PMID: 7014792.

21. Maruo N, Morita I, Shirao M, Murota S. IL-6 increases endothelial permeability in vitro. Endocrinology. 1992; 131:710–714. PMID: 1639018.

22. Nakaguchi H, Yoshimasu N, Tanishima T. [Relationship between the natural history of chronic subdural hematoma and enhancement of the inner membrane on post-contrast CT scan]. No Shinkei Geka. 2003; 31:157–164. PMID: 12616651.

23. Nomura S, Kashiwagi S, Fujisawa H, Ito H, Nakamura K. Characterization of local hyperfibrinolysis in chronic subdural hematomas by SDS-PAGE and immunoblot. J Neurosurg. 1994; 81:910–913. PMID: 7965121.

24. Park HR, Lee KS, Shim JJ, Yoon SM, Bae HG, Doh JW. Multiple densities of the chronic subdural hematoma in CT scans. J Korean Neurosurg Soc. 2013; 54:38–41. PMID: 24044079.

25. Park SH, Kang DH, Park J, Hwang JH, Hwang SK, Sung JK, et al. Fibrinogen and D-dimer analysis of chronic subdural hematomas and computed tomography findings : a prospective study. Clin Neurol Neurosurg. 2011; 113:272–276. PMID: 21156338.

26. Saito K, Ito H, Hasegawa T, Yamamoto S. Plasmin-alpha 2-plasmin inhibitor complex and alpha 2-plasmin inhibitor in chronic subdural hematoma. J Neurosurg. 1989; 70:68–72. PMID: 2521247.

27. Sajanti J, Majamaa K. High concentrations of procollagen propeptides in chronic subdural haematoma and effusion. J Neurol Neurosurg Psychiatry. 2003; 74:522–524. PMID: 12640081.

28. Schnabel C, Di Martino E, Gilsbach JM, Riediger D, Gressner AM, Kunz D. Comparison of beta2-transferrin and beta-trace protein for detection of cerebrospinal fluid in nasal and ear fluids. Clin Chem. 2004; 50:661–663. PMID: 14981039.

29. Senturk S, Guzel A, Bilici A, Takmaz I, Guzel E, Aluclu MU, et al. CT and MR imaging of chronic subdural hematomas : a comparative study. Swiss Med Wkly. 2010; 140:335–340. PMID: 20349366.

30. Shono T, Inamura T, Morioka T, Matsumoto K, Suzuki SO, Ikezaki K, et al. Vascular endothelial growth factor in chronic subdural haematomas. J Clin Neurosci. 2001; 8:411–415. PMID: 11535006.

31. So SK, Ogawa T, Gerberg E, Sakimura I, Wright W. Tracer accumulation in a subdural hygroma : case report. J Nucl Med. 1976; 17:119–121. PMID: 1245872.

32. Stroobandt G, Fransen P, Thauvoy C, Menard E. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Acta Neurochir (Wien). 1995; 137:6–14. PMID: 8748860.

33. Vaquero J, Zurita M, Cincu R. Vascular endothelial growth-permeability factor in granulation tissue of chronic subdural haematomas. Acta Neurochir (Wien). 2002; 144:343–346. discussion 347. PMID: 12021880.

34. Weigel R, Schilling L, Schmiedek P. Specific pattern of growth factor distribution in chronic subdural hematoma (CSH): evidence for angiogenic disease. Acta Neurochir (Wien). 2001; 143:811–818. discussion 819. PMID: 11678402.