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Mayo Clinic Rochester, MN 55905
By W. Richard Webb, Nestor L. Müller, and
David P. Naidich. Philadelphia: Lippincott Williams & Wilkins, 629 pp.,
2001. $135
The organization of the book is well conceived and logical. Chapter 1 presents the basic technical aspects of HRCT. The authors explain the importance of using optimum imaging parameters to obtain the best scans for lung evaluation. Particular emphasis is placed on the use of proper window level and width settings to avoid the simulation of disease by suboptimal settings. Anyone who has viewed HRCT scans obtained at window levels of less than 1000 H knows that increased contrast at such a level can cause an apparent increase in the size of bronchial walls, mimicking airway disease. Other topics discussed include prone scanning, postexpiratory images, and an explanation and description of common artifacts. Information about a number of recommended HRCT protocols for various suspected lung diseases is particularly helpful for the novice.
Detailed knowledge of normal lung anatomy is necessary to recognize and understand the pathologic appearance of diseased lung. Chapter 2 presents an in-depth review of normal lung structures and emphasizes the importance of the secondary pulmonary lobule in the evaluation of lung diseases. Numerous HRCT images of normal lungs, both in vivo and isolated, and multiple excellent line drawings illustrate the lobular anatomy clearly.
Chapter 3 describes in detail the basic HRCT findings of lung disease, including linear and reticular opacities, nodules and nodular opacities, increased lung opacity, decreased lung opacity, cysts, and airway abnormalities. These basic findings alone and in combination characterize most disease processes that occur in the lungs. Emphasis is placed on the usefulness of the pattern of distribution of parenchymal abnormalities in differential diagnosis. Tables of differential diagnoses are included for all major lung abnormalities. The depth of the discussion is impressive.
The next four chapters all focus on diseases that are characterized primarily by one of the previously described basic abnormalities. These chapters are quite complete. Other individual chapters highlight airway disease and pulmonary vascular disease. A final discussion of the clinical utility of HRCT is especially useful and could be read alone for its insightful review of the published literature from the perspective of critics who have the knowledge and experience to fairly evaluate the relative value of these articles.
At the end of the book is a comprehensive illustrated glossary of the generally accepted vocabulary of HRCT of the lung that is well done. A knowledge of this vocabulary is a prerequisite for properly describing the normal and abnormal findings on HRCT. Another section that is new to this edition is a small atlas of high-resolution lung images of 38 of the most commonly encountered diffuse lung diseases from acute interstitial pneumonia to tuberculosis. This "Quick Reference" guide should be helpful to anyone who needs a fast overview of classic cases to help in evaluating a problem case and arriving at a reasonable differential diagnosis.
Those who own the second edition of this book are justified in asking if it is worthwhile to buy the third edition. I suggest that anyone who found the second edition worthwhile would certainly want this one. In the past 5 years, considerable advances have been made in our understanding of the nature, causes, and characteristics of diffuse pulmonary diseases. These advances are discussed in this new edition, which includes updated information on the often-confusing interstitial pneumonias, expanded discussions of other common lung diseases such as small and large airways disease, and the addition of a section on pulmonary vascular diseases. A handy new addition is a number of diagnostic algorithms that can help the reader reach a diagnosis based on specific HRCT findings. Although they are no substitute for experience, algorithms can be helpful particularly for the less experienced. Even for the experienced radiologist, an algorithm can jog one's memory and help lead to the most likely diagnosis.
High-Resolution CT of the Lung is up-to-date. I looked up several diseases that are better understood now than they were 5 years ago to see how much new information was added. One example, nonspecific interstitial pneumonia, is a relatively recently described entity that some radiologists may not be aware of. Although this disease was not even included in the last edition, I found slightly more than three pages of material about it in this new edition. The text includes a definition and description of nonspecific interstitial pneumonia as well as the clinical presentation and common conventional radiographic findings. The HRCT findings are described and accompanied by a brief literature review of five papers that were published between 1995 and 2000. Also included are six HRCT images of nonspecific interstitial pneumonia and a separate table that lists the HRCT findings. I found this to be a complete but concise description of this disease. Other diseases that I reviewed were described in similar depth.
An abundance of excellent illustrations is seen throughout. High-Resolution CT of the Lung contains hundreds of well-reproduced HRCT images, line drawings, microscopic views of lung biopsy specimens, and numerous tables describing the HRCT findings in selected diseases. The text is extremely well written, authoritative, and succinct. The book itself is attractive, with a sturdy binding and high-quality paper.
It is difficult to find any meaningful negatives. Perhaps some would lament the growing bulk that has occurred with the past two editions; however, I do not see how the book could be trimmed without excluding important information.
In my opinion, High-Resolution CT of the Lung is the most authoritative and complete volume available on this topic. Anyone who interprets chest CT images should own this book or at least have it available in a nearby library. For those who have the second edition, the third edition is an essential update. If one is too busy to read the book from beginning to end, I suggest that, for a quick overview, the sections to read first are those on normal lung anatomy, basic HRCT findings of lung disease, and clinical utility of HRCT. The illustrated glossary of HRCT terms and the quick reference images should also be beneficial as a quick review. Specific diseases can be read about as they are encountered in daily practice. The book is reasonably priced, which should make it affordable for both practicing radiologists and residents.
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