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HelpTest Code NSESF Neuron-Specific Enolase (NSE), Spinal Fluid
Reporting Name
Neuron Specific Enolase, CSFUseful For
An auxiliary test in the diagnosis of Creutzfeldt-Jakob disease
An auxiliary test in the diagnosis of small cell lung carcinoma metastasis to central nervous system or leptomeninges
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
CSFSpecimen Required
Container/Tube: Sterile vial
Specimen Volume: 0.5 mL
Specimen Minimum Volume
0.3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| CSF | Refrigerated (preferred) | 15 days | |
| Ambient | 72 hours |
Reference Values
Normal: ≤15 ng/mL
Indeterminate: 15-30 ng/mL
Elevated: >30 ng/mL
Elevated results may indicate the need for additional workup. Possible causes may be neuron-specific enolase-secreting central nervous system/leptomeningeal tumor or rapid neuronal destruction from a variety of causes. In the context of dementia, elevated results may be suggestive of Creutzfeldt-Jakob disease.
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83520
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| NSESF | Neuron Specific Enolase, CSF | 44802-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| NSESF | Neuron Specific Enolase, CSF | 44802-7 |
Clinical Information
Enolase is a glycolytic enzyme that catalyzes the conversion of 2-phosphoglycerate to phosphoenolpyruvate. Enolase exists in the form of several tissue-specific isoenzymes, consisting of homo or heterodimers of 3 different monomer-isoforms (alpha, beta, and gamma). Neuron-specific enolase (NSE) is a 78 kDa gamma-homodimer and represents the dominant enolase-isoenzyme found in neuronal and neuroendocrine tissues. Its levels in other tissues, except erythrocytes, are negligible. The biological half-life of NSE in body fluids is approximately 24 hours.
Due to this organ specificity, concentrations of NSE in serum or, more commonly, cerebrospinal fluid (CSF) are often elevated in diseases that result in relative rapid (hours/days to weeks, rather than months to years) neuronal destruction. Measurement of NSE in serum or CSF can therefore assist in the differential diagnosis of a variety of neuron-destructive and neurodegenerative disorders. The most common application is in the differential diagnosis of dementias, where elevated CSF concentrations support the diagnosis of rapidly progressive dementias, such as Creutzfeldt-Jakob disease (CJD). NSE might also have utility as a prognostic marker in neuronal injury. For example, there is increasing evidence that elevated serum NSE levels correlate with a poor outcome in coma, in particular when caused by hypoxic insult.
Interpretation
The diagnosis of Creutzfeldt-Jakob disease (CJD) is highly complex and involves clinical history and neurologic examination; detection of characteristic periodic sharp and slow wave complexes on electroencephalographs; magnetic resonance imaging (hyperintense basal ganglia); and exclusion of other possible causes of dementia, in addition to cerebrospinal fluid (CSF) examination. Consequently, patients are often diagnosed as having possible, probable, or definite CJD based upon the constellation of clinical findings. Detection of elevated CSF levels of NSE protein in these patients assists in the final diagnosis.
A CSF neuron-specific enolase (NSE) within the normal reference range makes sporadic CJD very unlikely but can be observed in less rapidly progressive forms of CJD, such as variant CJD related to infection with prions that cause bovine spongiform encephalopathy. With the previous Mayo Clinic-developed assay, in a group of carefully pre-selected patients with a probable diagnosis of CJD and an indeterminate or elevated NSE concentration in CSF, the respective diagnostic sensitivities of approximately 87% and approximately 80%, and diagnostic specificities of approximately 66% and approximately 83% were observed.
Small cell lung carcinoma central nervous system metastases, particularly if they involve the leptomeninges, will lead to, usually substantial, elevations in CSF NSE concentrations.
Report Available
1 to 3 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | Reject |
Day(s) Performed
Monday through Saturday
Specimen Retention Time
2 weeksMethod Name
Homogeneous Time-Resolved Fluorescence