2020, Number 3
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Rev Cubana Invest Bioméd 2020; 39 (3)
Software for cerebrospinal fluid diagnostics and statistics
Reiber H
Language: English
References: 22
Page: 1-14
PDF size: 449.51 Kb.
ABSTRACT
Background:
In CSF analysis for diagnostics we have knowledge-based software for numerical and graphical data interpretation, but software programs for statistics are scarce. Free, stand-alone software programs that calculate all individual functions of CSF protein analysis and allow the statistical treatment of groups of diseases numerically and graphically are presented for relevant examples.
Methods:
Diagnosis of an intrathecal synthesis refers to the upper limit of the reference range, Qlim = Qmean +3SD, but statistical evaluation of its frequency is referred to Qmean+2SD. When quantifying intrathecal synthesis for statistics, either the absolute amount (IgGloc) or the relative intrathecal fraction (IgGIF) can be reported with reference to the mean reference curve, Qmean. The free software “CSF research Tool” for immunoglobulins allows diagnostic and statistic evaluations with Reibergrams and calculation of mean values and standard deviations from disease groups. The software “FLC-K statistics” for free light chains Kappa offers for diagnostics and statistics the numerical and graphical interpretation basis for statistical processing in exported Excel tables. A free “CSF-App” for Smartphones provides data calculation for diagnostics of single patients with examples of disease-related data patterns.
Results:
Patients with clinically isolated syndrome (CIS) who were later diagnosed as MS showed no immunological differences to patients initially diagnosed as MS (same mean quantity of intrathecal synthesis in CIS and MS detectable for IgG and FLC-K). The frequently claimed diagnostically higher sensitivity of the FLCK analysis compared to IgG, can be explained by the up to 3-fold higher mean intrathecal fraction of FLC-K, corresponding to a higher frequency in the detection of intrathecal synthesis with FLCK analysis.
Conclusions:
With a knowledge-based quantification in CSF analysis, supported by knowledge-based software programs, scientifically and diagnostically important results can be obtained.
REFERENCES
Reiber H, Peter JB. Cerebrospinal fluid analysis - disease-related data patterns and evaluation programs. J Neurol Sci. 2001;184:101-22.
Dorta-Contreras AJ. Reibergramas: elemento esencial en el análisis inmunológico del líquido cefalorraquídeo. Rev Neurol. 1999;28:996-8.
Regeniter A, Kuhle J, Mehling M, Möller H, Wurster U, Freidank H, et al. A modern approach to CSF analysis: Pathophysioly, clinical application, proof of concept and laboratory reporting. Clin Neurol Neurosurg. 2009;111(4):313-8.
Akaishi T, Narikawa K, Suzuki Y, Mitsuzawa S, Tsukita K, Kuroda H, et al. Importance of the quotient of albumin, quotient of immunoglobulin G and Reibergram in inflammatory neurological disorders with disease-specific patterns of blood-brain barrier permeability. Neurol Clin Neurosci. 2015;3(3):94-100. DOI:10.1111/ncn3.158
Reiber H. Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases: Diagnostic patterns not to be missed in Neurology and Psychiatry. Arq Neuropsiquiatr. 2016;74(4):337-50.
Albaum W. CSF-Lab. Labororganisation für das Liquorlabor; 2020 [access: 21/01/2020]. Available at: Available at: http://www.albaum.it
Wormek A. Desktop application as knowledge-based system for cerebrospinal fluid (CSF) analysis; 2020 [access: 21/01/2020]. Available at: Available at: http://www.wormek.org
Protis system. Automated CSF assessment; 2020 [access: 21/01/2020]. Available at: Available at: http://www.siemens-healthineers.com/diagnostics-it
Reiber H. Knowledge-base for interpretation of Cerebrospinal fluid data patterns - Essentials in Neurology and Psychiatry. Arq Neuropsiquiatr. 2016;74(6):501-512.
Reiber H. Flow rate of cerebrospinal fluid (CSF) - a concept common to normal blood-CSF barrier function and to dysfunction in neurological diseases. J Neurol Sci. 1994;122:189-203.
Reiber H. Proteins in cerebrospinal fluid and blood: Barriers, CSF flow rate and source-related dynamics. Rest Neurol Neurosci. 2003;21:79-96.
Reiber H, Zeman D, Kušnierová P, Mundwiler E, Bernasconi L. Diagnostic relevance of Free light chains in Cerebrospinal fluid - The hyperbolic reference range for reliable data interpretation in quotient diagrams. Clin Chim Acta. 2019;497:153-62.
Reiber H, Albaum W. Statistical evaluation of intrathecal protein synthesis in CSF/Serum quotient diagrams. Acta Neuropsychiatrica 2008; 20 (Supplement 1): 48-49
Bechter K, Reiber H, Herzog S, Fuchs D, Tumani H, Maxeiner HG. Cerebrospinal fluid analysis in affective and schizophrenic spectrum disorders. Identification of subgroups with immune responses and blood-CSF barrier dysfunction. Journal Psychiatric Research. 2010;44:321-30.
Link H, Tibbling G. Principles of albumin and IgG disorders. Evaluation of IgG synthesis within the central nervous system in multiple sclerosis. Scan J Clin Lab Invest. 1977;37:397-401.
Albaum W. CSF -App; CSF Research Tool/Reibergrams; FLC-K Statistics and Graphic program; 2020 [access: 12/04/2020]. Available at: Available at: http://www.albaum.it
Pesslauer S, Milosavljevic D, Huebl W, Aboulenein-Djamshidian F, Krugluger W, Deisenhammer F, et al. Validation of kappa free light chains as a diagnostic biomarker in multiple sclerosis and clinically isolated syndrome: A multicenter study. Mult Scler. 2016; 22:502-10.
Reiber H, Teut M, Pohl D, Rostasy K.M, Hanefeld F. Paediatric and adult Multiple Sclerosis: Age Related Differences and time course of the neuroimmunological response in Cerebrospinal fluid. Multiple Sclerosis. 2009;15:1466-80.
Reiber H. Polyspecific antibodies without persisting antigen in multiple sclerosis, neurolupus and Guillain-Barré syndrome: immune network connectivity in chronic diseases. Arq Neuropsiquiatr. 2017;75(8):580-8. DOI: 10.1590/0004-282X20170081
Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292-302.
Villar LM, Espiño M, Costa-Frossard L, Muriel A, Jiménez J, Álvarez-Cermeño JC. High levels of cerebrospinal fluid free kappa chains predict conversion to Multiple sclerosis. Clin Chim Acta. 2012;413:813-6.
Jarius S, Eichhorn P, Franciotta D, Petereit HF, Akman-Demir G, Wick M, Wildemann B. The MRZ reaction as a highly specific marker of multiple sclerosis: re-evaluation and structured review of the literature. J Neurol. 2017;264(3):453-66. DOI: 10.1007/s00415-016-8360-4