Neuroradiology Third Series, Test and Syllabus, Vol. 51

doi:10.3174/ajnr.A0836

M. Castillo and J.G. Smirniotopoulos, eds. Reston, Va: ACR Publications; 2006, $180.00 member, $250 nonmember, $98.00 member-in-training.

The time-honored American College of Radiology (ACR) Test and Syllabus now has its newest neuroradiology book edited by Drs. Mauricio Castillo and James Smirniotopoulos, with 5 additional contributors: Drs. Falcone, Rumboldt, Fukui, Smith, and Mukherji. While this syllabus is aimed at residents studying for the American Board of Radiology (ABR) examination and perhaps fellows/attendings studying for a Certificate of Added Qualification/Maintenance of Certification in neuroradiology, it can serve as a brief self-test for anyone doing a substantial amount of clinical neuroradiology. The subject matter is, of course, divided into brain, spine, and head/neck with an appropriate smattering of cases with different etiologies. There are 20 separate case categories, with each of these containing 6 or 7 additional cases to establish differential points.

As is often the situation in such syllabi, some ambiguity is present in a number of the questions—for instance knowing exactly what is meant by “rare,” “infrequent,” or “occasional”; what percentage each of those words connotes has always been a problem. A typical example is where one part of a question states that a given entity is “rare” and the reader is asked to indicate true of false. Also when there is a discussion about the disease, the text will say that the entity is “not uncommon.” (Is that the same as common?) These are types of questions/answers that should be carefully scrutinized and reworded in all these ACR syllabi before publication.

The publisher and copy editor of this syllabus should have paid more attention to avoiding scrambled/incoherent sentences such as, “Most posterior circulation aneurysms originate from the termination (apex or dome) of the is considered to be supratentorial.” -[sic].

Those and other misgivings notwithstanding, this collection of cases will be instructive to the resident preparing for the ABR examinations, though I have to presume that everything covered in this book will have been dealt with in a strong residency program. It does, however, nicely bring together the main teaching points for all the entities shown.

For the most part, the images are well chosen (one does wonder, however, what the purpose is of showing isolated tentorial enhancement secondary to venous engorgement due to cavernous sinus invasion by a pituitary edema, when the actual pituitary lesion is not shown) and generally properly described (again, however, one wonders at the description of an “intrasellar Rathke's cleft cyst” when an arrowhead points to a hypointense area within the skull base). One could also question why, in showing cavernous sinus thrombosis, just postcontrast CT and MR imaging are included—the case begs to have the noncontrast studies more fully show the abnormality. A few manuscript editing problems are present, but none of these issues take away from the strong brain teaching cases shown. In fact, additional and complementary images (such as unusual locations for signal-intensity abnormalities in the point-resolved spectroscopic sequence) provide solid and interesting adjuncts to the more typical cases. Also the numerous tables that accompany many of the cases, such as distribution of intracranial aneurysms, the signal intensity of blood in various stages on MR imaging, etiologies of venous/sinus thrombosis grading of aneurysms, and the numeric classification system for neck nodes, all add to the teaching value of the cases. In many of the case presentations, salient and important clinical information accompanies the images. Thus for instance, in the case demonstrations of cerebral aneurysms, there is an excellent discussion of modern treatment options.

Case selection is balanced in terms of clinical importance and difficulty. In reading through all selections, one encounters cases that not only are expected on an ABR examination but also are typical of those seen in a busy neuroradiology practice. This, along with the accompanying discussions and follow-up questions, makes this syllabus valuable.

This book should be added to every department library, and for others who enjoy this type of format, it provides a strong self-assessment in neuroradiology.