Test Id : SFIG
Cerebrospinal Fluid IgG Index Profile, Serum and 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
Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| SFINC | IgG Index, CSF | No | Yes |
| SFIGS | IgG, S | No | Yes |
| ALBS1 | Albumin, S | Yes, (order ALB) | Yes |
Method Name
A short description of the method used to perform the test
SFINC, SFIGS: Nephelometry
ALBS1: Photometric
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
Albumin
Cerebrospinal Fluid (CSF) IgG Index
CSF (Cerebrospinal Fluid) Specific Protein IgG (Immunoglobulin G), Albumin
CSF Index
CSF, Specific Protein IgG, Albumin
IgG (Immunoglobulin G) Index
IgG (Immunoglobulin G) Spinal Fluid
IgG (Immunoglobulin G) Synthesis Rate
IgG Index
IgG Synthesis Rate
Synthesis Rate IgG
Albumin Ratio
Specimen Type
Describes the specimen type validated for testing
CSF
Serum
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Both serum and spinal fluid are required.
-Spinal fluid must be obtained within 7 days of serum collection.
-Two individual serum samples are required.
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: 2 Plastic vials
Specimen Volume: 2 mL in 2 plastic vials, each vial containing 1 mL
Collection Instructions: Within 2 hours of collection, centrifuge and aliquot serum into 2 plastic vials.
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Preferred: Collection vial number 2
Specimen Volume: 1 mL
Collection Instructions: Label specimen as SFINC.
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.
Serum: 1 mL in 2 plastic vials, each vial containing 0.5 mL; Spinal fluid: 0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Criteria apply to serum specimens only. For CSF specimens, the criteria are not applicable. | |
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | OK |
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 | ||
| Serum | Refrigerated (preferred) | 14 days | |
| Ambient | 7 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
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, neurosyphilis, acute inflammatory polyradiculoneuropathy, and subacute sclerosing panencephalitis may be due to local (intrathecal) synthesis of IgG.
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.
CSF index: 0.00-0.70
CSF IgG: 0.0-8.1 mg/dL
CSF albumin: 0.0-27.0 mg/dL
Serum IgG
0-4 months: 100-334 mg/dL
5-8 months: 164-588 mg/dL
9-14 months: 246-904 mg/dL
15-23 months: 313-1,170 mg/dL
2-3 years: 295-1,156 mg/dL
4-6 years: 386-1,470 mg/dL
7-9 years: 462-1,682 mg/dL
10-12 years: 503-1,719 mg/dL
13-15 years: 509-1,580 mg/dL
16-17 years: 487-1,327 mg/dL
> or =18 years: 767-1,590 mg/dL
Serum albumin
> or =12 months: 3,500-5,000 mg/dL
Reference values have not been established for patients who are younger than 12 months.
CSF IgG/albumin: 0.00-0.21
Serum IgG/albumin: 0.0-0.4
CSF IgG synthesis rate: 0-12 mg/24 h
Albumin quotient: <14
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 h 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, Staugaitis SM, Shapshak P. 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 Dec;27(12):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 Jan;33(1):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, Chiu, RWK, Burnham, CD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023
7. Saadeh RS, Ramos PA, Algeciras-Schimnich A, Flanagan EP, Pittock SJ, Willrich MA. An update on laboratory-based diagnostic biomarkers for multiple sclerosis and beyond. Clin Chem. 2022;68(9):1134-1150
Method Description
Describes how the test is performed and provides a method-specific reference
CSF IgG and albumin, and Serum IgG:
The cerebrospinal fluid (CSF) IgG, CSF albumin, and serum IgG are determined by immunonephelometry. The CSF IgG index and synthesis rate are calculated and reported.(Instruction manual: Siemens BN II Nephelometer Operations. Siemens, Inc.; Version 2.4, 07/2019
Serum albumin:
Serum albumin is measured by colorimetry. The dye, bromocresol green (BCG), is added to serum in an acid buffer. The color intensity of the blue-green albumin-BCG complex is directly proportional to the albumin concentration and is determined photometrically.(Package insert: ALB2. Roche Diagnostics; V 8.0, 06/2024)
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.
82040
82042
82784 x 2
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 |
|---|---|---|
| SFIG | CSF IgG Index Profile | 14116-8 |
| 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 |
| ALB_S | Albumin, S | 1751-7 |
| IGG_S | IgG, S | 2465-3 |
| AIGAS | IgG/Albumin, S | 6782-7 |
| ALBQ | Albumin Quotient, CSF/Serum | 1756-6 |