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Atlas of Spine Imaging

Allegheny General Hospital Pittsburgh, PA 15212

By Donald L. Renfrew. Philadelphia: Saunders, 376 pp., 2003. $129

This book, although titled an atlas, is really a combination atlas and brief text on the imaging of spinal disorders. The author has called on his experience working in a large outpatient facility in central Florida that sees a significant number of patients with neck and back abnormalities. Five contributors have assisted the author in six of the nine chapters. The chapters are titled "Anatomy," "Degenerative Disease," "Imaging of the Postoperative Spine," "Imaging of Spine Tumors," "Imaging of Trauma," "Infectious Spondylitis," "Congenital and Developmental Anomalies," "Spondylolysis," and "Miscellaneous Diseases of the Spine."

Each chapter is profusely illustrated. Readers will appreciate that most of the CT and MR images are full size. Furthermore, convenient algorithms in chapters 3–6 guide the reader along diagnostic and management pathways. The author's concern about terminology used in imaging reports has led to his incorporating into chapter 2 the lexicon established by the North American Spine Society and the American Society of Neuroradiology. Chapter 9, on miscellaneous spinal disorders, is nicely presented with the definition, imaging findings, differential diagnosis, clinical significance, and reporting listed for each entity.

Chapter 2 is the longest—118 pages. Its length probably reflects the patient population the author sees in Florida and the prevalence of degenerative diseases of the spine in the population as a whole. The end of this chapter portrays a variety of patients for whom the pertinent clinical history is given along with dermatome drawings of their symptoms. The images follow. Unfortunately, the interpretation of those images is not given until the end of each presentation, something that I find an inconvenience.

The illustrations overall are good. Many of the images, however, differ significantly in quality. Although one can see the abnormalities portrayed in almost all the images, many of the MR images could be sharper, have more contrast, and be less grainy. Perhaps their appearance reflects the source: they went directly from PACS (picture archiving and communication system) to computer printer. The few radiographs are all of poor quality. The CT scout images are uniformly washed-out. The CT images themselves are the most uniform.

One glaring shortcoming of this imaging atlas is the paucity of radiographs. Radiographs should be obtained in all patients who have had spinal surgery. Radiographs give the radiologist a superb overview of the type of surgery that has been performed, particularly when surgical implants are present. In patients with suspected tumors or other osseous diseases of the spine, the radiograph is often diagnostic of the type of lesion present. In congenital anomalies, radiographs give an overview of the type of abnormality present. Finally, in the trauma setting, radiographs once again provide an overview, even though their use is diminishing in the face of multi-detector CT technology.

One additional absence is a selection of cases in which vertebroplasty has been performed. Vertebroplasty is now being used in a variety of conditions as an effective and minimally invasive method of stabilizing the spine. I would hope to see this topic covered in a second edition of this book.

Despite these shortcomings, I believe the Atlas of Spine Imaging provides a concise compilation of a variety of spinal disorders that one would encounter in a busy practice. I recommend it to an audience of general radiologists.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Daffner, R. H. Search for Related Content PubMed Articles by Daffner, R. H. Social Bookmarking                      What's this?