Book Review

Essentials of Skeletal Radiology

N Engl J Med 1996; 334:1675-1676June 20, 1996

Article

Essentials of Skeletal Radiology
Second edition. Edited by Terry R. Yochum and Lindsay J. Rowe. 1526 pp. in two volumes, illustrated. Baltimore, Williams and Wilkins, 1996. $225. ISBN: 0-683-09330-4

More than 100 years have passed since Roentgen discovered the x-ray, and this textbook is a testimony to a century of progress in musculoskeletal imaging. Combining historical facts, original references, chronologic precision, practical information, capsule summaries, differential diagnoses, medicolegal implications, and most important, abundant and excellent images, these two volumes would interest anyone studying or practicing musculoskeletal radiology. It is a basic, no-nonsense textbook that should be required reading for any student of radiology.

These volumes had their beginnings in the careers of two remarkable educators, Lindsay Rowe and Terry Yochum, who share a love of and passion for the practice of musculoskeletal radiology and, although often widely separated geographically, were able to collaborate with obvious success. It is rare in radiology to witness the emergence of such a publication with its unique point of view and, at the same time, such extensive attention to detail and day-to-day routine. This textbook is indeed special and will serve as a reference for the development of skeletal radiology for succeeding generations.

There are chapters on positioning, normal anatomy, normal anatomical variants, and measurements. There are basic limited discussions of computed tomography, conventional tomography, diskography, myelography, magnetic resonance imaging, and scintigraphy in musculoskeletal radiology. The historical perspectives and basic technical aspects considered are superb for students of radiology. Chapters on the principles of radiologic interpretation, skeletal dysplasias, trauma, arthritis, tumors, and infections are excellent, well referenced, and clearly illustrated. There are refreshing historical perspectives on now archaic terms — for example, “Pott's puffy tumor,” which is a button sequestrum in the cranium with associated tuberculous cold abscess in the overlying scalp.

Vascular lesions, particularly aneurysms, are well illustrated (an unusual but welcome inclusion for musculoskeletal radiologists — for we often are the first to diagnose a calcified aneurysm). The inclusion of eponyms and mnemonics related to fractures will be useful to beginners in the field. The chapter on arthritic disorders will be excellent for rheumatology fellows and anyone interested in the radiology of rheumatologic disorders. The discussion of tumors is excellent and concise. Of particular interest are the superb discussion and illustrations of Paget's disease, fibrous dysplasia, and neurofibromatosis.

Some current topics not covered in these volumes are rotator-cuff and labral abnormalities of the shoulder and the spectrum of bone marrow edema and its relation to osteonecrosis. Magnetic resonance imaging of the knee and ankle is adequately discussed for beginners. The use of gadolinium, either intravenously or intraarticularly; arthrography; computed tomographic arthrography, and other more sophisticated imaging is not discussed.

An interesting chapter on report writing in skeletal radiology documents all the details involved in generating a report, now and in the past. The absence of such discussions in other textbooks makes one realize how diverse the process is. With computer-generated reports now possible, the ability to incorporate pertinent images into the body of a report may well revolutionize radiologic interpretation. Let us hope this will make for a clear, concise report that is appropriate to the patient's history and helpful to the health care provider. According to the authors, Emanuel Grigg (The Trail of the Invisible Light, from X-Strahlen to Radio(bio)logy. Springfield, Ill.: Charles C Thomas, 1965) suggested adding the following to every radiology report:

P.S. This report does not mention:

(1) a few shadows which were not seen because they were not looked at, nor

(2) those shadows which may have been looked at but were not seen because of their small size, lack of contrast, or similarly obscuring factors, and certainly not

(3) the shadows which (although both looked at and seen) were ignored because the signer of this report has not yet learned what significance, if any, they have!

Nancy Baker, M.D.
Brigham and Women's Hospital, Boston, MA 02115