Imaging of the Nervous System: Diagnostic and Therapeutic Applications, Vols. 1 and 2

Edited by Richard E. Latchaw, John Kucharczyk, and Michael E. Moseley. Philadelphia, Pa: Elsevier Mosby; 2005, $295.

The ever-growing field of neuroradiology requires knowledge of basic and clinical sciences, as well as multi-imaging techniques. The authors set out with the ambitious goal of providing an integrative approach to these subjects. To meet this goal, they recruited a total of 153 contributors, most of whom are well known in their respective fields. There is representation from neuroradiologists, physicists, neurologists, neurosurgeons, neuroanatomists, and physiologists. With their help, Drs. Latchaw, Kucharczyk, and Moseley have created a comprehensive textbook covering state-of-the-art diagnostic and therapeutic techniques, while providing the necessary scientific and clinical background to make the reader a more effective communicator with nonradiology colleagues.

The book is divided into 7 major parts. Part 1 addresses imaging principles. There is ample discussion of MR imaging, CT, positron-emission tomography (PET), single-photon emission CT or tomography (SPECT), functional MR imaging (fMRI), MR spectroscopy, magnetoencephalography (MEG), and magnetic source imaging (MSI). The second part is the most extensive. It is divided into 8 sections focusing on cerebrovascular disease.

The first 2 chapters are rarely found in a radiology textbook. They discuss the pathophysiology of cerebral ischemia and the epidemiology and clinical presentation of stroke and include animal models of ischemia and the biochemistry of stroke. The next chapter is one of this reviewer’s favorites. It consists of a series of beautifully illustrated plates describing the functional anatomy of the brain as it relates to different vascular territories. These illustrations are followed by a detailed section on stroke imaging. It includes CT, MR imaging, diffusion-weighted imaging, diffusion tensor imaging, and sodium MR imaging.

The subsequent section gives a comprehensive discussion of cerebral perfusion imaging. Chapters cover xenon-enhanced CT, CT perfusion, contrast and arterial spin-labeled MR perfusion, and SPECT. The chapter on MR perfusion emphasizes the mathematics and physics behind this technique. Radiologists in private practice might not find this chapter interesting; however, it contains a great table at the end summarizing suggested scanning parameters for a stroke protocol.

The following section emphasizes the vascular imaging of stroke and includes conventional angiography, MR angiography (MRA), CT angiography, and transcranial and carotid Doppler sonography. The MRA chapter proves to be the best one in this section. There is a thorough review of technique, pitfalls, and imaging optimization. The inclusion of transcranial Doppler sonography is interesting in a radiology textbook because this technique has been taken over primarily by neurologists. This chapter is well written and straightforward.

Section 5 seems to be most relevant for neurointerventional radiologists and stroke neurologists. It primarily describes different endovascular approaches used in the treatment of stroke and atherosclerotic disease. There is also discussion on the use of intravenous tissue plasminogen activator (tPA). This section is followed by a discussion of the pathophysiology, clinical presentation, and epidemiology of nontraumatic intracranial hemorrhage. The seventh section emphasizes the imaging of different causes for intracranial hemorrhage including a chapter on the appearance of blood on MR imaging at different stages. Part 2 of this book culminates in a discussion of the imaging and treatment of cerebral aneurysms and vascular malformations.

Part 3 discusses nonvascular disease entities of the brain. It is the second longest part and is divided into 8 sections. The first section covers both intra- and extra-axial brain neoplasms. There is a brief discussion on the evaluation of these entities with diffusion, perfusion, and PET imaging. The chapter on extra-axial masses provides valuable tables on the differential diagnosis of various lesions based on location. A chapter on metastatic disease will be a favorite of radiology residents studying for the boards as well as practicing radiologists. It provides a series of tables giving differential diagnoses based on imaging findings (eg, leptomeningeal enhancement). This chapter is followed by an equally excellent summary of head trauma imaging.

The next section deals with infectious, inflammatory, and demyelinating diseases of the brain. There are excellent chapters discussing infections in both the immunocompetent and immunocompromised host. These chapters emphasize the use of diffusion and perfusion imaging as well as MR spectroscopy. A brief chapter on demyelinating disease focuses on multiple sclerosis. The next section deals with orbital disease, including masses, trauma, and inflammation. It is comprehensive, well illustrated, well written, and is followed by an equally excellent discussion of sellar and suprasellar lesions. Section 6 discusses brain and spine CSF flow with many CSF flow cine examples provided. Degenerative, metabolic, and neurobehavioral disease are well covered in the next section. The last section includes epilepsy imaging and provides emphasis on fMRI, PET, SPECT, MEG, and MSI.

Part 4 is a brief but excellent discussion of pediatric imaging. Topics include normal brain development and cerebrovascular, metabolic, and neurodegenerative diseases, as well as epilepsy. There are examples of normal in utero development evaluated by MR imaging and also one of the most comprehensive tables this reviewer has seen on normal brain myelination. A chapter on metabolic diseases has exquisite images with MR spectroscopy correlation. The chapter on epilepsy presents material that has already been covered elsewhere in the book, and unfortunately, some of the images in this chapter are suboptimal.

Part 5 is a bit unusual for a radiology textbook. It has an all-inclusive discussion of “Image Guidance for the Therapy of Parenchymal Disorders.” CT- and MR imaging–guided neuronavigation systems and a chapter on intraoperative sonography are areas that would be most useful for a neurosurgeon. The next chapter on CT-guided aspirations and biopsies concentrates on skull base lesions; most radiologists who perform biopsies will enjoy reading it. The following chapters cover interventional MR imaging systems, cryotherapy, thermal therapy, MR imaging–guided endovascular procedures, and drug therapy. Although these chapters are interesting, they will probably be useful only for the small group of interventional neuroradiologists performing these highly subspecialized procedures.

Part 6 treats the reader to the emerging field of MR imaging of the peripheral nervous system and includes a very useful section on technique. The most common disease entities are well represented and are augmented by beautiful schematic representations.

The last part discusses spine imaging and intervention. It is divided into 2 sections: degenerative disease and pain management, and nondegenerative diseases. The first chapter discusses the most common subject that neuroradiologists face on a day-to-day basis—degenerative spine disease. It takes the reader though the natural history of classification and surgical complications of these diseases. It contains a plethora of crisp images that make the chapter very enjoyable. The next chapters discuss the controversial field of diskography and imaging-guided spine pain management. The second section of this part opens with spine trauma with an emphasis on CT and MR imaging, including a discussion on the importance of MR cine imaging in the diagnosis of delayed complications. A brief introduction to vertebroplasty is provided in the next chapter. Additional chapters discuss neoplasms and inflammatory and infectious processes of the spine. The book ends with excellent chapters on evaluation and treatment of vascular lesions of the spine, spine biopsies, and congenital anomalies of the spine. Some subjects that this reviewer would like to see within the spine section of the book in future editions include Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, rheumatoid arthritis, ankylosing spondylitis, and hereditary motor and sensory neuropathies.

Also provided is a valuable CD-ROM, which contains all 3100 images with accompanying legends and case studies. It includes a search function that displays all the images related to 1 subject. Moreover, one can then import selected images into PowerPoint for Windows (Microsoft, Redmond, Wash) and create a presentation.

Overall, Drs. Latchaw, Kucharczyk, and Moseley have created a comprehensive and innovative book on the diagnosis and treatment of the nervous system. Its integration of radiology, physics, physiology, and clinical medicine is a refreshing and unique approach on the subject. The book provides the reader state-of-the-art techniques and crisp images. Radiologists, neurologists, neurosurgeons, and physicists conducting nervous system research would very likely find this book extraordinarily useful.