Test Id : SFINC
Cerebrospinal Fluid (CSF) IgG Index, Spinal Fluid
Useful For
Suggests clinical disorders or settings where the test may be helpful
Aiding in the diagnosis of multiple sclerosis and other central nervous system inflammatory conditions using cerebrospinal fluid specimens
Method Name
A short description of the method used to perform the test
Only orderable as part of a profile. For more information see SFIG / Cerebrospinal Fluid IgG Index Profile, Serum and Spinal Fluid.
Nephelometry
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
CEREBROSPINAL FLUID INDEX
IgG Index
IgG Synthesis Rate
MS Panel
Multiple Sclerosis Panel
Synthesis Rate IgG
Specimen Type
Describes the specimen type validated for testing
CSF
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Only orderable as part of a profile. For more information see SFIG / Cerebrospinal Fluid IgG Index Profile, Serum and Spinal Fluid.
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Specimen Volume: 1 mL
Collection Instructions: Label specimen as spinal fluid.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| All specimens will be evaluated at Mayo Clinic Laboratories for test suitability. |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| CSF | Refrigerated (preferred) | 28 days | |
| Ambient | 14 days | ||
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Aiding in the diagnosis of multiple sclerosis and other central nervous system inflammatory conditions using cerebrospinal fluid specimens
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Elevation of IgG in the cerebrospinal fluid (CSF) of patients with inflammatory diseases of the central nervous system (CNS), such as multiple sclerosis (MS), neurosyphilis, acute inflammatory polyradiculoneuropathy, and subacute sclerosing panencephalitis, may be due to local (intrathecal) synthesis of IgG. Elevations of CSF IgG or the CSF/serum IgG ratio may also occur as a result of permeability of the blood brain barrier, and hence, a correction using albumin measurements in CSF and serum is appropriate.
The CSF index is the CSF IgG to CSF albumin ratio compared to the serum IgG to serum albumin ratio. The CSF index is, therefore, an indicator of the relative amount of CSF IgG compared to serum. Any increase in the index reflects IgG production in the CNS. The IgG synthesis rate is a mathematical manipulation of the CSF index data and can also be used as a marker for CNS inflammatory diseases. The test is commonly ordered with oligoclonal banding or immunoglobulin kappa free light chains in CSF to aid in the diagnosis of demyelinating conditions.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Only orderable as part of a profile. For more information see SFIG / Cerebrospinal Fluid IgG Index Profile, Serum and Spinal Fluid.
CSF index: 0.00-0.70
CSF IgG: 0.0-8.1 mg/dL
CSF albumin: 0.0-27.0 mg/dL
CSF IgG/albumin: 0.00-0.21
CSF IgG synthesis rate: 0-12 mg/24 hours
Interpretation
Provides information to assist in interpretation of the test results
Cerebrospinal fluid (CSF) IgG synthesis rate indicates the rate of increase in the daily CSF production of IgG in milligrams per day.
A result greater than 12 mg/24 hours is elevated.
A CSF IgG index greater than 0.70 is elevated and indicative of increased synthesis of IgG.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
The cerebrospinal fluid IgG index can be elevated in other inflammatory demyelinating diseases such as neurosyphilis, acute inflammatory polyradiculoneuropathy, and subacute sclerosing panencephalitis.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Tourtellotte WW, Walsh MJ, Baumhefner RW, et al: The current status of multiple sclerosis intra-blood-brain-barrier IgG synthesis. Ann NY Acad Sci. 1984;436:52-67
2. Bloomer LC, Bray PF: Relative value of three laboratory methods in the diagnosis of multiple sclerosis. Clin Chem. 1981;27:2011-2013
3. Hische EA, van der Helm HJ: Rate of synthesis of IgG within the blood-brain barrier and the IgG index compared in the diagnosis of multiple sclerosis. Clin Chem. 1987;33:113-114
4. Thompson AJ, Banwell BL, Barkhof F, et al: Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-73. doi: 10.1016/S1474-4422(17)30470-2
5. Gurtner KM, Shosha E, Bryant SC, et al: CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes. Clin Chem Lab Med. 2018 Jun 27;56(7):1071-1080. doi: 10.1515/cclm-2017-0901
6. Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018
Method Description
Describes how the test is performed and provides a method-specific reference
Cerebrospinal fluid (CSF) and serum IgG and CSF albumin are determined by immunonephelometry. The CSF IgG index and synthesis rate are calculated and reported. Albumin in serum is determined by turbidimetry (bromocresol green method). The serum IgG and albumin, CSF IgG and albumin, and serum and CSF IgG/albumin ratios are reported.(Instruction manual: Siemens Nephelometer II Operations. Siemens, Inc; Version 2.4, 07/2019)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
82042
82784
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| SFINC | IgG Index, CSF | No LOINC Needed |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| INDEX | IgG Index, CSF | 14117-6 |
| IGG_C | IgG, CSF | 2464-6 |
| ALB_C | Albumin, CSF | 1746-7 |
| AIGAC | IgG/Albumin, CSF | 2470-3 |
| SRATE | Synthesis Rate, CSF | 14116-8 |