Ben Weppner / Dr. Hooman Kamel - Week 3

Week 3: 06/19/23-06/23/23

This week, I joined Dr. Santosh Murthy in the neuro ICU at WCMC. I enjoyed seeing that even though the medical team consisted of different members from the week prior, such as a different attending physician, fellows, residents, and a physician assistant, everyone in the medical team was well-informed on the patients who had been treated by others. I believe this communication between team members is very important in order to provide the best care for the patients. Also, I found it interesting to see how patients were doing from when I first saw them. While some were doing much better, unfortunately there were others who were doing worse. 

I was also able to join Dr. Elcin Zan again in the neuroradiology reading room. Dr. Zan provided constant teaching moments when reading the scans, such as teaching the anatomy of where each lobe of the brain is and how to identify them on an MRI scan. Also, she described how enhancement in the brain on MRI means that vessels are leaky and tracer is escaping because the tracer molecules, such as gadolinium-based tracers, must leave the vessels to enter the extracellular extravascular space where the enhancement can be seen. Therefore, enhancement outside of vessels means that there is some sort of problem in the brain. I really enjoyed the opportunity to learn new things about MRI, specifically of the brain, given its relevance to my research.

For research, I focused on learning how to co-register MRI images using FLIRT and brain extraction tool (BET) from the FMRIB Software Library (FSL). Using a T1 FLAIR sequence as a reference, I was able to co-register both a perfusion weighted image (PWI) sequence and a diffusion weighted image (DWI) sequence to the respective patient's T1 FLAIR sequence in order for the PWI and DWI sequences to be overlapped in the correct anatomical orientation. This is very important for perfusion-diffusion mismatch because this method compares the mismatch and its volume between the PWI and DWI sequences in order to predict the non-core hypoperfused tissue following acute ischemic stroke known as the penumbra and oligemia. This PWI-DWI mismatch has been used clinically for determining whether reperfusion therapy could be successful or not.

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