Week 1 - An Introduction to Neuroradiology

 I met with my summer mentor, Dr. Gloria Chiang this week and was able to see how neuroradiologists investigate various scans of the brain and spinal cord. I learned that there are several sequences for each type of scan, each of which permits different types of views of the head and can be used to rule out potential causes of seizures or other health issues. In MRA (Magnetic Resonance Angiography) for instance, D2 sequence brightens the cerebrospinal fluid and is good for searching for brainstem abnormalities, T1 sequence is a sort of “bread and butter” structural analysis sequence, and Flare sequence suppresses any signal from the cerebrospinal fluid. I was able to observe as my clinician mentor went through multiple brain scans. My favorite scans to observe were ones of a young child, an elderly patient, and a glioblastoma survivor. The scans showing the brain of a young child compared to the brain of an elderly person showed just how much the brain atrophies over time. While brain atrophy seems to be somewhat inevitable with age, the particular location of where this atrophy occurs can lead to Alzheimer's and dementia. In the scans from a long term glioblastoma survivor, I was able to see the cavities within the frontal lobe of the brain where the tumor tissue had been surgically removed, as well as where the new tumors were beginning to appear.

I also learned that there exists quite a bit of controversy in the field of neuroradiology. One area of controversy surrounds the MRI (Magnetic Resonance Imaging) procedure. MRI contrast is produced by a heavy metal called gadolinium, which is delivered intravenously. While the procedure can leave deposits of the metal in the brain, there have been no documented long term health consequences. Despite this, several people have been claiming that the gadolinium used for the MRI procedure may potentially result in long term health effects. It was interesting to learn that this controversy exists, despite the fact that there has been no research to support these claims and that this procedure has been performed for several decades in much the same way. Another area of controversy in the field I noticed was that some neuroradiologists disagree with the notion that age is the main cause of brain atrophy over time. I was able to hear the opinions of some neuroradiologists who believe that patients are sometimes told that their levels of brain atrophy are normal for their age, despite there possibly being other underlying health causes which contribute to the level of atrophy that go ignored due to the patient’s age.

Finally, I was able to shadow Dr. Chiang while she met with patients to perform procedures. She took on two procedures this week, a CT scan for a patient who had been in a physical altercation and a Lumbar Puncture for a patient who was showing signs of meningitis. From the CT scan, she was able to deduce that the patient had subcutaneous emphysema tracking along their face and neck. The other procedure, a Guided Diagnostic Lumbar Puncture, allowed for the patient’s spinal fluid to be collected for lab testing. Overall, I feel that I got to learn a lot about the field this week. Next week, I hope to get better at recognizing issues in the brain structure and have the opportunity to witness other procedures.