Abstract Details

Title Clinical Utility of Cerebrospinal Fluid MOG-IgG Testing in Patients with Paired Serum and CSF Testing

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 02 (3:00 PM-4:00 PM)

Poster/Presentation
Number 1-027

Objective

To evaluate the diagnostic utility and cost of cerebrospinal fluid (CSF) myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) testing using commercially available fixed cell-based assay (CBA) in paired serum-CSF samples.

Background The diagnostic value of CSF MOG-IgG testing remains uncertain, particularly when performed using commercially available fixed cell-based assays. We evaluated the diagnostic utility and cost of CSF MOG-IgG testing in patients with paired serum and CSF samples.

Design/Methods We performed a retrospective diagnostic accuracy study at a large academic center. Adult patients tested in serum and/or CSF from January 2024 to February 2026 were identified. Paired samples were serum and CSF obtained within 7 days. Serum testing used live CBA and CSF testing fixed CBA at external laboratories. Sensitivity, specificity, predictive values, and exact McNemar testing were calculated using serum as reference. Costs were estimated from vendor pricing.

Results Among 94 patients with paired testing, 17 (18.1%) were serum-positive. Of these, 14 were CSF-negative and 3 positive in both serum and CSF. No patient was CSF-positive while serum-negative. CSF sensitivity was 17.6% and specificity 100.0%. Mean estimated cost per CSF test was 632 USD, totaling 59,408 USD over 2 years.

Conclusions Commercially available fixed-CBA CSF MOG-IgG testing provided no incremental yield beyond serum testing in this cohort and incurred substantial cost. Unlike prior studies using live CBA, which showed higher sensitivity and detected CSF-restricted cases, our findings support limiting CSF testing to selected seronegative patients, ideally with live CBA.

Authors/Disclosures
Thor Linnet, MD PRESENTER	Dr. Linnet has nothing to disclose.
Farrah J. Mateen, MD, PhD, FAAN (Northwestern University Department of Neurology)	Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from Amgen. The institution of Dr. Mateen has received research support from TG Therapeutics. Dr. Mateen has received intellectual property interests from a discovery or technology relating to health care.
Shailee S. Shah, MD	Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Shah has received publishing royalties from a publication relating to health care.

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