Test Catalog

Test Id : SFIG

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Cerebrospinal Fluid IgG Index Profile, Serum and Spinal Fluid

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Overview

Test Catalog

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.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

CSF IgG Index Profile

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
Frozen 28 days
Ambient 14 days
Serum Refrigerated (preferred) 14 days
Frozen 28 days
Ambient 7 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 2.3, 2008; Addendum to the Instruction Manual 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

No

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.

2 to 5 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

See Individual Test IDs

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

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.

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

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
File Definition - Result ID 2024-12-19