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MRI and CT of the brain
  1. IVAN MOSELEY

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    MRI and CT of the brain. Edited by james e gillespie andalan jackson (Pp 299, £75.00). Published by Arnold, London, 2000. ISBN 0 340 761 210.

    Several large scale textbooks cover much the same ground as this fairly modest, 300 page volume. It is questionable whether the information it contains would be adequate for someone practising or training as a specialist neuroradiologist and, indeed, the preface indicates that it is aimed at general radiologists and those in training, rather than subspecialists. It might be suitable for neuroscience trainees. However, given that, the readers' needs differ substantially from those of the subspecialist, who will already have a grounding in the subject. What does it offer the generalist who has to report on CT and MRI studies?

    Part 1 contains two 20 page atlases, one of normal anatomy as displayed by MRI and CT, and another of brain (actually intracranial) pathology. The former contains a sufficient number of typos: “mammilary body”, “thalmus” (both repeated), “tuberculum sella”, “gyrus recti” to confuse the unwary, plus terms recognised in “radiologists' anatomy” but not found in anatomists' texts, such as “tectal” and “suprasellar” cisterns. This is probablynot what generalists hoping to hone their neuroradiological skills need. What they do require, but will not find here, are extensive examples of confusing normal variants, artefactual abnormalities, and things which resemble others the management of which is radically different. In this respect, the implied message on page 38, for example, that extensive parenchymal calcification on CT usually indicates metabolic disease (and should presumably prompt further investigation) is not overly helpful.

    In Part 2, eight chapters, each with about 20 pages and 30 illustrations, deal with the usual topics: trauma, congenital abnormalities, infections and inflammatory diseases, etc, and two shorter ones cover hydrocephalus and “advanced techniques in neuroradiology”. The last has, I think, no part in such a book: most of what it deals with, although generating grants and increasing congress expenses in academic departments, has nothing to do with clinical neuroradiology in the DGH—or anywhere else. Conversely, a more exhaustive treatment of hydrocephalus would have been justified, given the frequency with which it raises its ugly head in reports by non-specialist radiologists, and the confusion created by most texts on its imaging and diagnosis. Possibly the authors, too, found it a difficult topic; they certainly repeat the chestnut that flow void in the third ventricle on T2 weighted images indicates communicating hydrocephalus, the error of which is demonstrated anew by figs 1.29 (lissencephaly), 1.26 (agenesis of the corpus callosum), and 6.26 (lacunes).

    It is difficult to know how much room to give rare conditions; several things a generalist is unlikely to encounter are both described and illustrated, whereas some more common lesions receive less detailed attention. Only one chapter gives a list of protocols for investigation based on clinical presentation which, although one might quarrel with minor details, does seem what the generalist needs. Another (on trauma) essentially deals with a single presentation, and rightly emphasises the value of CT; given its target audience, it could be argued that the text as a whole might more sensibly have been arranged along such lines (acute headache, epilepsy, dementia) and/or by radiological appearances (calcified masses, small periventricular high signal foci on T2 weighted images, multiple ring enhancing lesions), with at least one specific chapter on children, rather than assuming that the reader already has a good idea whether he or she is looking for or at a neoplastic, inflammatory, or congenital lesion. Unfashionable (and, for the DGH radiologist, economically unpopular) though it may be to say so, many queues in which patients camp for months outside their MRI units would disappear overnight were the experts to come clean and confess that that most things which really matter can be shown by CT of modest quality!

    The editors work in Manchester, which may explain their claim in the preface that CT dates from 1973 (when it arrived there, more than a year after Ambrose started work at Atkinson Morley's). Most of the contributors (12 neuroradiologists and one scientist—a physicist, I presume) are relatively young. Their literary talents vary, but the chapters are in general well prepared and the standard of the illustrations is high; frank errors are relatively rare. Given the British provenance of the book I was, as usual, distressed by the arguably excessive reliance of almost all the contributors on the transatlantic literature. Some chapters are heavily, others sparsely referenced; the index is reasonably full.

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