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HelpTest ID NSESF Neuron-Specific Enolase (NSE), Spinal Fluid
Specimen Required
Container/Tube: Sterile vial
Specimen Volume: 0.5 mL
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
Secondary ID
81796Useful 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
Method Name
Homogeneous Time-Resolved Fluorescence
Reporting Name
Neuron Specific Enolase, CSFSpecimen Type
CSFSpecimen Minimum Volume
0.3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | |
|---|---|---|---|
| CSF | Refrigerated (preferred) | 15 days | |
| Ambient | 72 hours |
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.
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.
Cautions
Do not interpret neuron-specific enolase (NSE) levels in spinal fluid as absolute evidence for the presence or absence of malignant disease. Results must be used in conjunction with information from the clinical evaluation of the patient and other diagnostic procedures.
Interferences or artefactual elevations should be suspected if the clinical NSE test results are at odds with the clinical picture of other tests. The laboratory should be contacted for assistance in these situations.
Hemolysis can lead to significant artefactual NSE elevations since erythrocytes contain NSE. Hemoglobin concentrations as low as 20 mg/dL were shown to cause invalid NSE concentrations.
Proton pump inhibitor treatment, hemolytic anemia, hepatic failure, and end-stage kidney failure can also result in artefactual NSE elevations.
Other false-positive results depend on the testing context. When performing NSE testing for tumor diagnosis or follow-up, recent epileptic seizures, brain injury, encephalitis, stroke, and rapidly progressive dementia might result in false-positive results.
When NSE testing is performed to assist in the diagnosis of Creutzfeldt-Jakob disease (CJD), recent epileptic seizures, brain injury, encephalitis, stroke, and NSE-secreting tumors can cause false-positive NSE elevations in cerebrospinal fluid (CSF).
There is insufficient evidence to support CSF NSE measurements in the prognostic evaluation of coma patients. Serum NSE should be used for this application, in conjunction with clinical predictors (pupillary light responses, corneal reflexes, motor responses to pain, myoclonus, status epilepticus), electroencephalogram, sensory-evoked potentials, and imaging.
NSE values can vary significantly between methods and assays. Serial follow-up should be performed with the same assay. If assays are changed, patients should have their baseline level reestablished.
This assay is an immunometric assay, and can, in rare situations, be affected by false-low results in the presence of extremely high NSE concentrations ("hooking") or autoantibodies to NSE.
In rare cases, some individuals can develop antibodies to mouse or other animal antibodies (often referred to as human anti-mouse antibodies [HAMA] or heterophile antibodies), which may cause interference in some immunoassays. Caution should be used in interpretation of results, and the laboratory should be alerted if the result does not correlate with the clinical presentation.
Day(s) Performed
Monday through Saturday
Report Available
1 to 3 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
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