Week 2 - A New Perspective on Neuroradiology and the Beginnings of a Research Project

Over the course of the past week, I have been teaching myself how to better read MRI and CT scans of the brain. My mentor, Dr. Gloria Chiang provided websites and recorded lectures to help me learn the pathology of the brain, which I have been studying in my free time. I’ve found that since beginning to study brain anatomy and pathology, I am having an easier time recognizing many of the medical terms that Dr. Chiang uses when diagnosing patients. On some (rare) occasions, I am even able to look at an MRI or CT scan and make out what is wrong immediately.

I was also able to see more procedures. Dr. Chiang had three more guided lumbar punctures this week. One of these lumbar punctures, unlike the others from this week and the previous week, was not meant for the collection and testing of cerebrospinal fluid. Instead, this patient was receiving a lumbar puncture as a means of getting cancer treatment. This type of guided lumbar puncture is called intrathecal chemotherapy. It is performed for patients with blood cancers which have spread to the space around the brain and spine. The blood-brain-barrier (BBB) makes it difficult for chemotherapeutics administered intravenously to permeate into the brain and spine. Thus, when cancer cells have spread to the brain or spine or are likely to soon spread there, intrathecal chemotherapy is provided. A CT scan is used to locate a location and position that the needle can be safely inserted into the spine without causing paralysis. Then, a small amount of cerebrospinal fluid is removed to help maintain pressure balance within the spine. The chemotherapy drug is then slowly pulsed into the cerebrospinal fluid, where it circulates and makes its way to the brain. From this experience, I saw that neuroradiologists are not only involved in the diagnosis of disease, but are also sometimes involved in the treatment of disease. The experience awakened within me a new perspective on the specialty.

This week I also learned what my summer research project would be about. I will be using Quantitative Susceptibility Mapping (QSM) to analyze MRI scans of patients with Multiple Sclerosis (MS) and Cerebral Small Vessel Disease (SVD). To prepare for this research, I began reading about QSM, MS, and SVD. I learned that QSM is an MRI contrast technique that allows for the spatial distribution of magnetic susceptibility in tissue to be calculated and quantified, thus creating a map of the tissue’s molecular composition and cellular architecture based on differences in magnetization. MS and SVD are two different neurological diseases, but have several similarities and can act on brain tissue in similar ways as well. Most notably, both diseases result in cerebral white matter demyelination and brain atrophy. Perhaps analysis of MS and SVD afflicted brains using QSM will allow for better comparison of their demyelination patterns and permit better understanding of the mechanism of action for each. I’m looking forward to officially beginning my research project and speaking more in depth about it in future blog posts. I also look forward to meeting with other clinicians in order to retrieve the amount of data I’ll need to complete my project.