Brain, Vol. 123, No. 6, 1281-1282,
June 2000
© 2000 Oxford University Press
Book reviews |
NEUROIMAGING. Volumes 1 and 2.
.
Radiology Directorate, University Hospital of Wales, Cardiff, UK
Wilhelm Roentgen's description of `A New Kind of Rays' was published in December 1895, his discovery of X-rays having been made on November 8 that year. By November 1896, Harvey Cushing, the pioneering American neurosurgeon, had used X-rays to aid him in the diagnosis of neurological disease by demonstrating the presence of a bullet lodged in the C6 vertebral body of one of his patients. The rest, as they say, is history.
The field of neuroimaging in all its guises has grown exponentially since those early days, slowly at first through the era of precision skull radiographs performed on dedicated skull tables to air encephalography, contrast myelography and early angiography right up to the present day when not only are we able to demonstrate neuroanatomy in exquisite detail but have various tools with which to image the functioning brain.
The need for surgeons to visualize brain structure as an aid to diagnosis and treatment planning was the driving force behind many early developments. Latterly, developments have been largely driven by quantum technological leaps such as the invention of computerized tomography (CT) and, of course, MRI. With the advent of these latter modalities, neuroimaging has become a key component in the diagnosis and management of most neurological conditions, be they primarily medical or surgical.
The ability to visualize brain and spinal cord structure in such detail and to be able to detect the effect of various pathological processes on nervous tissue non-invasively has revolutionized many aspects of the practice of neurology and neurosurgery. Advanced MR techniques such as diffusion and perfusion-weighted imaging have pushed back the barriers a little further and are again advances which were crucially dependent on improvements in both MR hardware and software.
The study of structure alone, no matter how appealing the images, is only a part of the story. Using imaging modalities to visualize brain function has become a hot topic and is likely to remain so. The ultimate goal of functional imaging must be to image the actual electrical activity of neural tissue in real time. Most `functional' techniques really only image the consequences of neural activity such as increased blood flow. Radionuclide techniques demonstrate increased blood flow but with poor temporal resolution (minutes); blood oxygen level dependent (BOLD) MR functional imaging is better, demonstrating signal changes in effluent blood from an active area of brain within seconds of an increase in neural activity within that area. However, magneto-encephalography, looking at tiny variations in local magnetic field consequent upon neural electrical activity has the best temporal resolution (milliseconds).
Neuroradiologists are not content with just looking at pictures these days; they want to be doing things as well like embolizing aneurysms and arteriovenous malformations and performing angioplasty both in extra- and intracranial vessels. The field of interventional neuroradiology is developing as rapidly as diagnostic imaging although with such rapid advances in both fields one wonders how much longer the two can remain together in a unified subspecialty.
Neuroimaging as a whole may therefore be subdivided by modality (CT, MR, intervention, ultrasound) or by anatomical regions (ENT and head and neck imaging) or by age group (paediatric neuroradiology). There are excellent reference texts available for all of these admittedly somewhat arbitrary subspecialty divisions but there has not been an up to date multimodality, multisubspecialty text covering all of these topics. There is now.
When asked to review this text I was sceptical about the possibility of producing such a wide-ranging book, assuming that the coverage of individual topics would be too superficial to be of any use to specialists or that a few topics would be covered in such detail as to be daunting to the generalist or to those outside diagnostic radiology. I was wrong. This multi-author two volume set achieves all that it sets out to do, and the text is in the main written and edited in such a way as to strike a very happy medium between overview and detail.
The book is divided into four sections: history and technology; brain; head, neck and spine; and lastly paediatrics. Section 1 starts with a brief overview of the history of neuroradiology before going on to detail the science and technology which underlies the various imaging modalities in use today and also of specific techniques such as angiography and myelography. A large proportion of this section is taken up with chapters on ultrasound-related topics. This is a welcome inclusion given the fact that ultrasound normally gets relatively little room in general neuroimaging texts, but I did wonder whether its role justified such a prominent billing, especially when neurointervention has to manage with 43 pages without any mention of its role in the management of aneurysmal disease. Chapters 8 and 9 (cerebral angiography and neurointervention) shared very similar discussions on vascular access which more judicious editing could have filtered out, especially as the lead author for each chapter was the same individual. There are good descriptions of the techniques of CT and MR angiography (CTA and MRA). The quality of MR angiography has improved considerably over recent years with the constant improvement in scanner hardware and software. With CT, the introduction of spiral scanning has allowed the development of CTA, which, in good hands, can be as good as MRA. The section also includes useful chapters on MR artefacts (all those nasty blurry bits with funny-sounding names beloved of MR radiologists) and of MR bioeffects and safety.
Section 2, on the brain, contains well written chapters on the topics that one might expect such as brain tumours, cerebrovascular disease, infection and trauma but there are also gems of chapters on `The Normal Brain' and `Normal Variations of the Head', both topics of huge importance when attempting to interpret abnormality and both containing information not easily found elsewhere.
Section 3 covers ENT, orbital and maxillo-facial radiology in a thorough, well-organized manner, and even includes a chapter of case studies on temporomandibular joint imaging, which I thought novel. The illustrations in this chapter were good, which was just as well because I found the text somewhat heavy going and ended up with bilateral TMJ pain at the end of it, having had to grit my teeth so hard to get through it. The section then has several chapters devoted to imaging of the spine before finishing with two somewhat isolated chapters on the larynx and hypopharynx, which seem to have escaped from the earlier part of the section on the neck.
Section 4 is devoted to paediatrics, a subspecialty that encompasses the whole panoply of neuroimaging but with the added complication of `the fourth dimension': time. Children's brains obviously develop over time and the pathological processes which affect the adult brain may affect children's brains differently, and may also, of course, affect the developing brain in different ways according to the stage of development reached at the time of the insult. This is the shortest of the sections of the book as a whole, but despite this there is a huge amount of information packed into well-written chapters.
Radiology is all about images and a radiology text is nothing without those images as illustrations, no matter how good the text. In general the images in the book (over 3500 of them) are of good quality, relevant to the point they are chosen to illustrate and have been reproduced well. As most of the modalities discussed are digitally based there would be little excuse for poor reproduction of illustrations. There are inevitably a few illustrations that have been buried in someone's film collection for ages having been produced on a scanner years previously but which, like an old friend, are always there when you need them. These should have been edited out and better examples obtained, but they are few in number and I only really feel I have to mention them in order to criticize something about the book.
In order to succeed as a reference text there should be adequate references in each chapter to allow the reader to delve deeper into any aspect of interest. Those references should also be accurate. How many times have we all gone off to the library to hunt down a key article armed with a reference from a book or paper only to find the cited pages take you to the middle of an article on some completely unrelated topic? There are ample references after every chapter here and although I cannot claim to have checked each one, those that I have were all accurate. The index is well organized and comprehensive and, again, accurate. Topics are found where the index says that they will be found, a basic requirement but one not found universally in reference texts.
Overall, this is a superb book. In his preface, Dr Orrison states that his aim was to create a master reference file on the field of neuroimaging and for the text to be a resource for the fields of diagnostic radiology and neuroradiology, neurology and neurosurgery, psychiatry, psychology, neurophysiology and neurobiology. I have to say that by and large I think that he has achieved this and more. This is a comprehensive text on all aspects of neuroimaging that is actually also a good read. Most chapters contain little gems of information to satisfy the novice and the more experienced reader alike, including the answers to some of those questions one never likes to ask because you suspect that everybody else knows the answer and your ignorance would be their bliss! To have achieved this in a book with so many contributors, some of whom are very well known whilst others less so, is commendable and a tribute to Orrison as an Editor (despite my earlier minor criticisms), as he was also kept busy by co-authoring nine out of the 52 chapters.
Neuroimaging deserves to be a success and for those who may baulk at the cost, it is a fraction of the money one might spend on individual texts covering the same breadth of information.
Despite my jaw dropping at the size of the book when the review copy arrived, I have enjoyed reviewing it and using it as a source of information in my practice.
Notes
Edited by William W. Orrison, Jr. 2000. London: Harcourt International Publishers Ltd. Price £280. Pp. 1776. ISBN 0-7216-6801-1.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||