Book Review

Diagnostic Radiology: An Anglo-American Textbook of Imaging

N Engl J Med 1993; 328:738-739March 11, 1993

Article

Diagnostic Radiology: An Anglo-American Textbook of Imaging
Second edition. Edited by Ronald G. Grainger and David J. Allison. 2443 pp., in three volumes, illustrated. New York, Churchill Livingstone, 1992. $450. ISBN: 0-443-04112-1

Turn the clock backward 40 years, and think for a moment of the changes that have occurred in diagnostic imaging. In the fifth decade of the century, the field did not even include digital-subtraction angiography, diagnostic ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI), let alone coronary arteriography and angioplasty. It was possible to write a textbook of radiology and expect that virtually all subjects could be covered adequately in a single volume.

But then humanity's capacity for creative thought and innovative problem-solving produced a series of extraordinary breakthroughs. Techniques that we had not even dreamed of were designed, engineered, and applied in astonishing profusion.

It seems that no one could be courageous enough to tackle the monumental task of compressing the huge amount of information that has accumulated over this period into a single textbook. Yet that is exactly what Ronald Grainger, the former chief of radiology at Sheffield, and David Allison, current professor at Hammersmith, have attempted. And, mirabile dictu, they have come remarkably close to fulfilling their goals in these unusual volumes.

They have covered the field -- the new techniques and the “new” diseases -- and by and large have done a sterling job. They have carefully chosen their contributors, a distinguished group of British and American figures both in and outside the field of radiology, all with something to say that is important, contemporary, and well organized.

The first edition of this book appeared in 1986. The enlarged second edition contains 18 completely new chapters, including those on pediatric ultrasonography and nuclear medicine, industrial lung disease, interventional techniques in the thorax, MRI of the heart and circulation, interventional procedures in congenital heart disease, the radiologic manifestations of AIDS, interventional uroradiology, the urinary bladder and prostate, and many others. Twenty-one contributors from the first edition are no longer represented, but 46 have been added. All the chapters have been updated, some of them only slightly. For example, the chapter on ultrasonography has precisely the same illustrations and the same text as that in the first edition. There is, however, a new chapter on pediatric ultrasonography, which provides an excellent review of its applications. Similarly, in the chapter on CT there are some new illustrations and a few old ones have been removed, but the material is substantively unchanged. In contrast, the chapter on the basic principles of MRI has been much expanded, with more detail on pulse sequences and on MRI contrast agents, as might well have been anticipated in view of the dynamic character of the technology.

The first volume contains a section on techniques in imaging methods that is more or less technical in character. The following sections are centered on the respiratory system and the heart and great vessels, with a mixture of largely useful and informative radiographic illustrations and others that are substandard. Figure 20.1, for example, is so dark that the features pointed out in the legend are barely visible. The text is excellent, and the section on the heart and great vessels is particularly strong, with fine chapters by Grainger on congenital heart disease (not too much changed from the first edition) and a good basic chapter on MRI of the heart by Reese and Longmore. A major gap is the absence, both in this section and in the chapters on congenital heart disease, of appropriate emphasis on the extraordinary diagnostic yield of MRI in congenital anomalies. The angiocardiographic illustrations are profuse and elegant, whereas MRI, which may soon supplant angiocardiography in the visualization of many complex lesions, is slighted.

Volume 2 covers the gastrointestinal tract, the liver, biliary tract, pancreas, endocrine system, genitourinary tract, and part of the skeletal system. Each section is organized so that the reader may move in easy sequence through the field or may simply choose one area of particular interest. In the gastrointestinal section, for example, the breakdown is traditional: the appearance of the acute abdomen on plain films, the esophagus, the stomach, the duodenum, and so on. But there are also fine integrative chapters on a multimodal approach to the abdomen, endoscopy, and angiography, as well as an excellent discussion of AIDS in the gastrointestinal tract.

The final volume explores the skeletal system in further detail and covers the female reproductive system; the central nervous system; the orbit, ear, nose, and throat, and the face and teeth; angiography and interventional radiology; and the reticuloendothelial system, oncology, and AIDS. This volume is as well thought out and organized as volumes 1 and 2 and is of consistently high quality.

The broad scope of this book, as well as the goals of the authors, preclude it from serving as a reference work. Instead, it will function best as a general textbook for residents in training or as a book for rapid review by physicians in practice. Fortunately, there is a list of references and a bibliography in each section that point the reader toward more detailed sources when deeper inquiry is desired.

Grainger and Allison have taken on a herculean task and have achieved it far better than anyone might have predicted. The second edition maintains the great strengths of the first, with added sections and expertise, and with a sure approach to conveying accurate information to the reader in a lucid, succinct, and comprehensive manner, with generally excellent illustrations. Perhaps the only important omission is the failure consistently to present a series of diagnostic decision trees that represent graphically the sequence of multiple imaging examinations in all the situations in which they are applicable.

Herbert L. Abrams, M.D.
Stanford University School of Medicine, Stanford, CA 94305