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Transcranial Doppler Ultrasonography.
  1. PETER MARTIN

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    Transcranial Doppler Ultrasonography. Edited by viken l babikianand lawrence r wechsier. (Pp 409, £100.00). Published By Butterworth Heinemann, Oxford, 1999. ISBN0 7506 9969 8.

    In the 17 years since Aaslid's first description of transcranial Doppler ultrasonography (TCD) the technique has developed from a research tool to a routine clinical investigation, at least in some circumstances. This transition has been especially rapid in the 6 years since the first edition of this book was published in 1993. This second edition has grown in volume by 180 pages and now comprises 24 chapters organised into sections covering basic techniques and physics of Doppler ultrasound, cerebrovascular physiology, evaluation of cerebrovascular disease, monitoring for microemboli, intraoperative and intensive care monitoring, transcranial duplex imaging, paediatric applications, and the role of contrast media. To some extent the first edition of this book seemed to play second fiddle to the volume of Newell and Aaslid— Transcranial Doppler. Now however, with the introduction of several new chapter authors, this book is likely to occupy the prime place on the shelf of any clinician or technologist with an interest in transcranial ultrasound.

    Any book written by 42 authors is bound to have some overlap in content but the current edition is well edited and the illustrations (many in colour) are of high quality. Each chapter is comprehensively referenced. Particularly welcome to this edition is the chapter by David Evans, Professor of Medical Physics at Leicester University. The ability, or otherwise, of TCD devices to count embolic phenomena accurately and to distinguish particulate from gaseous emboli has been a point of some contention amongst workers in this field. Thus it is with some relief that here we have a physicist of some authority in the field of Doppler ultrasound trying to ensure that clinicians understand the limitations of the technique before making potentially inaccurate assumptions.

    Statements regarding the value of TCD monitoring during carotid endarterectomy are now all the more concrete given the work which has been published during the mid-1990s regarding this application, but much uncertainty remains over the exact clinical utility of TCD in other settings—for example, monitoring “vasospasm” or the patient with head injury. The relevant chapters provide a balanced summary of the available evidence. The section on colour coded trancranial imaging has enlarged significantly since the first edition and further technology such as power Doppler, three dimensional reconstruction, and echo contrast agents are comprehensively discussed. These technologies are rather at the stage at which TCD found itself a decade ago—that is, promising techniques awaiting a role. Quite possibly by the time the third edition of this book arrives in a few years time their clinical relevance will have been delineated.

    Overall this is a welcome summary of the TCD literature. I would not rush to replace my first edition of the book with this edition as much of what is contained in the first is not made redundant by the later edition. However, for those clinicians and scientists seeking an overview of TCD and its current status this text will suffice very well.

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