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Diagnostic and Surgical Imaging Anatomy: Musculoskeletal.

Vanderbilt University Medical Center Nashville, TN 37232

By B. J. Manaster, C. C. Roberts, C. L. Andrews, C. A. Petersilge, J. Crim. Philadelphia, PA: Amirsys, 1,200 pp., 2006. $249 (ISBN: 1-931884-31-0)

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This book is the second of three available hardcover texts published by Amirsys under the title of Diagnostic and Surgical Imaging Anatomy. The notably successful reference series adds this first-edition volume on musculoskeletal anatomy to the two other available titles: Brain, Head and Neck, Spine and Chest, Abdomen, Pelvis. In their introduction, the editors and executives describe the book as providing "detailed views of anatomic structures never before seen and discussed in an anatomy reference textbook." I am inclined to agree with them. By my count, the volume is more than 1,200 pages and is packed with thousands of finely detailed and accurate graphic illustrations and images.

The viability of a radiologic anatomy reference lies not only with its accuracy but also with its organization. The layout of the atlas has been well thought out. It is officially divided into eight sections covering the shoulder, elbow, wrist, hand, hip and pelvis, knee, and ankle and foot, although there are additional sections on the arm, forearm, thigh, and leg included with the nearest proximal joint. Each section begins with a thorough overview including a few pages of text filled with bulleted points concisely describing everything from muscular attachments to the boundaries of the relevant anatomic spaces. This introduction includes some pertinent imaging recommendations and pitfalls in image interpretation.

These pages are followed by a variety of labeled radiographs as well as three-dimensional and cross-sectional color illustrations worthy of commendation. Labeled high-field T1-weighted images of the anatomy in three planes are next. This arrangement enables a radiologist to quickly flip to the relevant image when all that is needed is to quickly identify which muscle in the anterior compartment of the forearm is invaded by a tumor or which tendon in the plantar aspect of the foot is abnormal. Unlike other atlases of this type, the slice interval of the MR images is quite small, moving through the anatomy in great detail. This avoids the common problem of not having the right reference image available when comparing the image to a patient's study at the viewbox. It is worth noting that each illustration is accompanied by an extensive figure legend fully describing some of the anatomy that may not lend itself to a succinct label.

The true strength of the book comes just after the overviews—comprehensive subsections highlighting the fine anatomy of the joint. Where appropriate, the authors use advanced imaging techniques and alternate MRI sequences to illustrate the structures. In the shoulder, detailed drawings and MRI arthrography images accurately define the labroligamentous structures including multiple anatomic variations in the configuration of the biceps–labral complex. With similar detail, an unmatched description of the extensor and flexor mechanism of the fingers is provided over the course of 16 pages. I also found the MRI arthrography images of the hip joint particularly well researched and complete, although just a bit grainy.

A unique feature of this atlas is the duplication of many of the axial and coronal MRI figures as mirror images on opposing pages, presented as left and right versions of the same labeled anatomy. Lynn Steinbach of the University of California, San Francisco, explains in her foreword to the text that this "makes it easier to identify structures within the extremities without having to transpose." Although these conversions are perhaps not a great challenge to most radiologists with reasonable visual–spatial skills (or a flip–horizontal tool button at their PACS station), most wouldn't mind avoiding these mental gymnastics. Even if slightly gimmicky, this feature should appeal to a wide variety of physicians and other clinicians who may use the reference. Readers should be aware that this mirrored duplication of images accounts for more than 170 pages and undoubtedly at least some of the purchase price.

One unfortunate shortcoming of this book is that many of the radiographs and MRI images included are reproduced with fairly low contrast. The washed-out images are particularly ubiquitous in the sections on the shoulder, hip, and pelvis. Although this is a tolerable deficiency, it does pose a slight hindrance when combined with dimly lit reading rooms. A small number of the MRI sequences also appeared slightly noisy, but not unacceptably so. Any other flaws in the huge volume are trivial.

Assembling an atlas of this quality is no small feat, and I enthusiastically recommend this book. The many accomplished contributing authors seemingly left no stone unturned in compiling an incredibly detailed and complete reference. With its well-organized massive array of images and illustrations, this is a very useful volume and is the ideal day-to-day reference for radiologists who interpret musculoskeletal studies. Even beyond that, many portions of the book could be considered an informative text worthy of a thorough review.

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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 Block, J. J. Search for Related Content PubMed Articles by Block, J. J. Social Bookmarking                      What's this?