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Elevated Surfactant Protein Levels and Increased Flow of Cerebrospinal Fluid in Cranial Magnetic Resonance Imaging

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Abstract

Surfactant proteins (SPs) are a multifunctional group of proteins, responsible for the regulation of rheological properties of body fluids, host defense, and cellular waste clearance. Their concentrations are changed in cerebrospinal fluid (CSF) of patients suffering from communicating hydrocephalus. Hydrocephalic conditions are accompanied by altered CSF flow dynamics; however, the association of CSF-SP concentrations and CSF flow has not yet been investigated. Hence, the aim of this study was to evaluate the association between SP concentrations in the CSF and marked CSF flow phenomena at different anatomical landmarks of CSF spaces. Sixty-one individuals (15 healthy subjects and 46 hydrocephalus patients) were included in this study. CSF specimens were analyzed for SP-A, SP-B, SP-C, and SP-D concentrations by the use of enzyme-linked immunosorbent assays (ELISA). CSF flow was evaluated in axial T2_turbo inversion recovery magnitude (TIRM)-weighted and sagittal T2-weighted magnetic resonance imaging sections using a 4-grade scale (1—no flow, 2—subtle flow, 3—moderate flow, and 4—strong flow). CSF-SP concentrations (mean ± standard deviation) of the overall collective were as follows: SP-A = 0.73 ± 0.58 ng/ml, SP-B = 0.17 ± 0.93 ng/ml, SP-C = 0.95 ± 0.75 ng/ml, and SP-D = 7.43 ± 5.17 ng/ml. The difference between healthy controls and hydrocephalic patients regarding CSF concentrations of SP-A (0.34 ± 0.22 vs. 0.81 ± 0.59 ng/ml) and SP-C (0.48 ± 0.29 vs. 1.10 ± 0.79 ng/ml) revealed to be statistically significant as calculated by means of ANOVA (p values of 0.022 and 0.007, respectively). CSF flow voids were detectable at all investigated landmarks of the CSF spaces (foramina of Monro, third ventricle, mesencephalic aqueduct, prepontine cistern, fourth ventricle, cisterna magna, and craniocervical junction). CSF flow voids, reported as mean ± standard deviation, revealed to be significantly increased in hydrocephalic patients compared to controls as calculated by means of ANOVA (respective p values are given in brackets following values of descriptive statistics) at the following sites: foramina of Monro (1.60 ± 0.91 vs. 2.37 ± 0.99, p = 0.01), fourth ventricle (1.67 ± 0.98 vs. 2.52 ± 1.05, p = 0.007), and the cisterna magna (1.93 ± 1.10 vs. 2.72 ± 1.13, p = 0.022). Spearman’s rank order calculation identified significant correlations for CSF flow voids at the foramina of Monro and the third ventricle with SP-A (r = 0.429, p = 0.001 and r = 0.464, p < 0.001) and CSF flow void at the mesencephalic duct with SP-D (r = − 0.371, p = 0.039). Furthermore, SP-C showed a moderate inverse correlation with age (r = − 0.302, p = 0.022). The present study confirmed statistically significant differences in SP-CSF concentrations between healthy controls and hydrocephalic patients. Additionally, significant correlations between SP concentrations in CSF with increased CSF flow were identified. These findings underline the role of SPs as regulators of CSF rheology.

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Author notes

  1. Matthias Krause and Ulf Quäschling contributed equally to this work.

Authors and Affiliations

  1. Department for Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    Stefan Schob, Alexander Weiß, Cindy Richter, Karl-Titus Hoffmann & Ulf Quäschling

  2. Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany

    Alexey Surov

  3. Department for Ophthalmology, University Hospital Leipzig, Leipzig, Germany

    Julia Dieckow

  4. Institute for Anatomy, University Hospital Leipzig, Leipzig, Germany

    Cindy Richter

  5. Department for Neurology, University Hospital Leipzig, Leipzig, Germany

    Mandy Pirlich

  6. Neuroradiological Clinic, Katharinenhospital Stuttgart, Stuttgart, Germany

    Diana Horvath-Rizea

  7. Paul Flechsig Institute for Brain Research, Medical Faculty / University Hospital Leipzig, Leipzig, Germany

    Wolfgang Härtig

  8. Department for Neurosurgery, University Hospital Leipzig, Leipzig, Germany

    Matthias Krause

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  1. Stefan Schob
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Correspondence to Stefan Schob.

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This study with retrospective design was approved by an institutional review board (Ethikkommission Universität Leipzig Az 330-13-18112013). Informed consent for the scientific use of CSF samples and clinical and radiological data were obtained in writing.

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Schob, S., Weiß, A., Surov, A. et al. Elevated Surfactant Protein Levels and Increased Flow of Cerebrospinal Fluid in Cranial Magnetic Resonance Imaging. Mol Neurobiol 55, 6227–6236 (2018). https://doi.org/10.1007/s12035-017-0835-5

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