Re: A couple of questions from a new member - MRCP, MELD

[Guest guest]

Hi Deb;

Here are answers to your questions about MRCP and MELD.

MRCP:

Gastroenterologist. 1998 Mar;6(1):82-7.

Magnetic resonance cholangiopancreatography: a new technique for

evaluating the biliary tract and pancreatic duct.

Fulcher AS, MA, Zfass AM.

Department of Radiology, Medical College of Virginia

Hospitals/Virginia Commonwealth University, Richmond 23298-0615, USA.

Magnetic resonance cholangiopancreatography (MRCP) represents a new

development in MR technology that provides a noninvasive accurate

means of evaluating the biliary tree and pancreatic duct. Recent

technical refinements that allow for imaging of the entire biliary

tree and pancreatic duct in 18 seconds make this examination easily

performed even in critically ill patients. The clinical applications

of MRCP are illustrated in a variety of scenarios that include

choledocholithiasis, malignant obstruction, incomplete/failed

endoscopic retrograde cholangiopancreatographies (ERCPs),

postsurgical alterations of the biliary tract and gastrointestinal

tract such as biliary-enteric anastomoses, intrahepatic bile duct

pathology such as sclerosing cholangitis and AIDS cholangiopathy,

chronic pancreatitis, congenital anomalies of the biliary tract and

pancreatic duct, and gallbladder pathology.

PMID: 9531120

MELD

http://www.thedrugmonitor.com/meld.html

MELD stands for Model End Stage Liver Disease (ESLD), a disease

severity scoring system applied to adult liver patients. The

pediatric version of the model is called PELD.

The MELD score replaces the Child-Turcotte-Pugh (CTP) score as a

disease severity index. This change is designed to improve the organ

allocation system in liver transplantion to ensure that available

organs are directed to transplant candidates based on the severity of

their liver disease rather than the length of time they have been on

the waiting list. These efforts have been prompted by the

socalled " final rule " issued in 1998 by the US Department of Health

and Human Services. This rule states that organs should be allocated

to appropriate transplant candidates based on medical urgency.

MELD score is calculated using a relatively simple formula that

relies on three readily available objective variables:

The Formula & The Calculator:

MELD Score = 10 {0.957 Ln(Scr) + 0.378 Ln(Tbil) + 1.12 Ln(INR) +

0.643}

Serum creatinine (Scr; mg/dL)

Total bilirubin (Tbil; mg/dL)

INR (international normalized ratio)

The following rules must (be) observed when using this formula:

1 is the minimum acceptable value for any of the three variables.

The maximum acceptable value for serum creatinine is 4.

The maximum value for the MELD score is 40.

Best regards,

(father of (19); PSC 07/03; UC 08/03)

> I am learning so much from you all (and also appreciate the ethical

> discussions). I have a couple of questions on terms used in the

emails. I

> am familiar with an ERCP, but what is an MRCP? Also, what exactly

is a MELD

> score? How is it figured?

>

> Thank you in advance

[Guest guest]

Deb,

A MRCP is basically a MRI of the liver and biliary system. Magnetic

Resonance Cholangiopancreatography (MRCP) when compared to ERCP is

a " less costly, non-invasive, and sensitive technique for evaluating

the biliary and pancreatic ductal systems. In MRCP, multiplanar

images are obtained parallel to the orientation of the biliary tree,

using an MR sequence that is sensitive to static fluid without the

need for exogenous contrast agents. Fluid in the ducts appears

bright against the darker tissue. Image post-processing (maximal

intensity projection) is used to make multi-dimensional images of

the entire biliary tree and the pancreatic ducts. Although MRCP

images have somewhat lower resolution than ERCP, MRCP shows the

ducts in their natural, non-distended state and can easily be

combined with MRI of the surrounding viscera " -

http://www.massgeneralimaging.org/newsletter/june_2004/june_2004.pdf

MELD (Model for End-Stage Liver Disease) scores are a measure of a

patients risk of dying from liver disease within three months. The

higher the score the greater the risk. The score is base on the lab

values of bilirubin, creatinine, INR and dialysis status. A

calculator (and more documentation) is available at -

http://www.unos.org/resources/MeldPeldCalculator.asp?index=98

Tim R

> I am learning so much from you all (and also appreciate the ethical

> discussions). I have a couple of questions on terms used in the

emails. I

> am familiar with an ERCP, but what is an MRCP? Also, what exactly

is a MELD

> score? How is it figured?

>

> Thank you in advance

[Guest guest]

/Tim,

Thank you

for your quick responses. So, if I

understand correctly, MRCP can be used for evaluation whereas ERCP can be both

for evaluation and also as therapy (dilatation or brushings).

Deb (mother of Sam (10); PSC 8/04)

[Guest guest]

Hi Deb;

Yes, that's correct. Here's a section from the PSC Support UK website

report of the Oxford 2004 meeting dealing with MRCP versus ERCP:

http://www..demon.co.uk/page7.html

DIAGNOSIS

" Once abnormal biochemistry is revealed on the LFTs, diagnosis is

made mainly on the basis of the cholangiogram. A liver biopsy may

also be taken. But MRCP (magnetic resonance imaging) is producing

ever clearer pictures. It's non-invasive and is replacing ERCP for

purposes of diagnosis. It eliminates the possibility of producing

infection in the bowel which is always a potential problem. We have

new machinery, new software and a committed Consultant Radiologist.

The downside is that they're noisy and a bit claustrophobic. Music is

often played to reduce this. ERCP is therefore changing its role and

will be used mainly for the manipulation of the bile ducts,

stretching and stenting etc. - more therapeutic oriented than

diagnosis oriented. It's part of the way forward. "

Best regards,

Dave

(father of (19); PSC 07/03; UC 08/03)

> /Tim,

>

> Thank you for your quick responses. So, if I understand correctly,

MRCP can

> be used for evaluation whereas ERCP can be both for evaluation and

also as

> therapy (dilatation or brushings).

>

> Deb (mother of Sam (10); PSC 8/04)