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Neuroimaging, Volumes 1 and 2.

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    Neuroimaging, Volumes 1 and 2. Edited by william w orrison jr (Pp 944 and pp 1776). Published by Harcourt International Publishers Ltd, London, 1999. ISBN 0-7216-6799-6.

    The express aim of the editor of this book was to create “a master reference file on the field of neuroimaging”. This may sound somewhat enigmatic, particularly as, in Europe at least, we recognise two ways of using imaging to look at the nervous system:neuroradiology, a clinical speciality practiced by organ specialised radiologists familiar with a wide range of techniques, closely related to the clinical neurosciences to which this journal is devoted—neurology, neurosurgery and psychiatry—andneuroimaging, usually the domain of physicists, psychologists, or neuroscientists expert in the application of a single technique, the impact of which on routine clinical practice has, it can be argued, often been negligible. A failure to distinguish clearly between the two markedly upsets the balance of this book.

    The text is divided into four sections: history and technology (16 chapters); brain (11); head, neck, and spine (13, of which only four deal with the spine); and paediatrics (10). In each, the space devoted to some subjects seems inversely proportional to their clinical impact. Thus, in section I, the physical basis of CT and MRI merits 24 pages, with 15 references, whereas functional MRI occupies 22 pages, supported by no fewer than 154 references. Functional MRI is in vogue but, come on chaps, what about a sense of proportion? If that were not enough, two chapters on radionuclide studies (PET and SPECT respectively) have 60 pages of text between them, with 1011 references; one could be forgiven for wondering if the author had simply downloaded his Reference Manager™! I can only suppose the reason magnetic source imaging takes up 22 pages, with 117 references, must be that it is one of the editor's hobby horses.

    To put things in perspective, a chapter of about 50 pages on cerebral angiography devotes 46 of those to anatomy, eight to technique, etc (of which two, on arch aortography, include the provocative statement that “the aortic arch angiogram should be evaluated before the vertebral arteries are cannulated”), and 10 lines to indications, including the questionable statement (in the age of MRI) that intra-arterial injection should be used to detect arterial dissection. I failed to find a description of spinal angiography or its indications. Spinal arteriovenous malformations or fistulae do not appear in the index.

    It would be tedious to go through the rest of the two volumes in the same way, but certain things stand out. Children's brain tumours, admittedly photogenic but usually not a source of significant diagnostic problems, occupy 80 pages (plus 651 references), while that most difficult and complex field, paediatric metabolic and endocrine disease, in which a source of definitive information, helpfully presented, would be particularly valuable for the jobbing neurologist, paediatrician, or neuroradiologist, is given rather superficial treatment in 23 pages, with 97 references. In several chapters, too many citations are of other radiology textbooks rather than of authoritative source material.

    The chapter on degenerative disease of the spine, written by musculoskeletal specialists who seem to deal principally with orthopaedic surgeons or rheumatologists, is out of place in a book on neuroimaging (however defined). It deals largely with plain films, and does not address the issues germane to neurological practice; furthermore, like a number of the contributions, it omits a discussion of postoperative appearances and surgical instrumentation, essential knowledge for today's clinicians. Chapter 50, on hydrocephalus and cerebrospinal fluid dynamics, should carry a hazard warning that it presents views so personal as to be not only idiosyncratic but potentially misleading. Conversely, the chapter on the orbit and visual system, sensibly concentrating on the use of CT for the former, is admirable, apart from the caption to figure 77: the lesion described as a dermoid is almost certainly a dermolipoma.

    Some 75 North American authors, few—as yet—major international figures, contributed to the 52 chapters, more than a dozen of which are the result of collaboration between at least three people. As this might lead one to expect, the literary and intellectual level, including the critical evaluation of the literature central to review-type chapters, is very variable. However, the illustrations are almost uniformly excellent and the 75 page index, included in both volumes, if also somewhat idiosyncratic, is generous. Much useful information is to be found between these hard covers, although for me the book fails to live up to the promise of the rather facetious foreword. Does it deserve a place on that already perilously overburdened departmental bookshelf? Neuroimagers will, I imagine, identify rival texts as more suited to their specially focused needs; trained neuroradiologists will indeed find much valuable reference material, but also some worrisome deficiencies and debatable notions.