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Neuroimaging: Clinical and Physical Principles.

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    Neuroimaging: Clinical and Physical Principles. Edited by ra zimmerman, wa gibby, and rf carmody. (Pp 1642, £124.00). Published by Springer-Verlag, New York, 2000. ISBN 0 387 94963 1.

    This large single volume textbook has almost 30 contributors. Many chapters are written by more than one person, but one of the editors has personally contributed almost a third of the text, including the first 11 chapters on “physical principles”: computed tomography (60 pages) and magnetic resonance imaging (350 pages). The remainder of the book is divided into four sections. “Clinical principles: normal anatomy and variants” consists of one chapter on “normal variations of the skull and its contents”, with 95 figures, but not a single skull radiograph or any reference to anomalies of the cerebral vasculature. There are 15 on “brain and skull”, rather heavily weighted towards children, which is perhaps not surprising given that the first editor is one of America's foremost paediatric neuroradiologists. The five chapters making up the “orbits, paranasal sinuses, and skull base” are distinctly disappointing, at least two probably best skipped over. The second of the seven chapters on “spine” is a rather superficial review of myelography, which to a European also seems anachronistic (although I am assured that many myelograms are still carried out in the United States for medicolegal reasons, which seems perverse!). The author claims that “in older patients, who generally have considerable cervical spondylosis and thoracic kyphosis, the C1–2 injection technique is preferred”. Leaving aside the agist slur on elderly Americans, many experienced neuroradiologists would firmly reject this.

    Curiously, there are no corresponding chapters on sonography or cerebral or spinal angiography, although chapter 23, “Interventional neuroradiology”, is written so as to suggest that the authors thought the latter topics would be covered elsewhere. Bizarrely, however, the chapter on “haemorrhage” in the principles of MRI section, offers “tips” on angiographic diagnosis of intracranial haemorrhage! Chapter division is rather idiosyncratic throughout, so that, for example, inflammatory disease of the spinal cord is dealt with under “brain and skull”, whereas inflammatory spinal column disease comes 500 pages later. There is significant repetition, two contributors illustrating a metopic suture, and Alzheimer's disease crops up in about half a dozen different places.

    In the 1980s, postgraduate students often sought a recommendation for a single volume neuroradiology textbook. Now there is a handful to choose from, and it is difficult to pick a winner: most, like this one, have merits and failings, some to a greater degree. The choice might be guided by the space left on that quasitheoretical “departmental shelf”; at £124 for a very well produced radiology book, “Neuroimaging” is certainly not unduly expensive. Another text, recently published with the same title, was more obviously oriented towards that no man's land between neuroradiology and neurology which in Europe is usually referred to as “neuroimaging”. This one is very definitely a neuroradiology text: “Neuroimaging and nuclear medicine” is relegated (appropriately, some would say) to the 13 page appendix B, which includes three and a half pages of text on “clinical applications”.

    The text is moderately well written, accepting that not all the authors have English as their first language, but the index could have been better. The illustrations are generally of very good quality (although there are some appalling graphics in chapter 14, and the legends of some figures in chapter 19 do not say what conditions they show). My favourite thing is figure 11.95. The caption, which I quote in its entirety, similarly does not draw attention to the specific radiological features, and one can only wonder whether the author is settling some heartfelt score: “This is a coronal CT scan of a thick-skinned 73-year-old retired businessman”!

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