Pediatric Neuroradiology: Brain, Head, Neck, and Spine (2 Volumes)

doi:10.3174/ajnr.A0577

P. Tortori-Donati and A. Rossi, eds. New York: Springer; 2005. 1752 pages, 4480 illustrations, $779.

For years, the standard against which I have judged texts on the subject of pediatric neuroimaging has been A. J. Barkovich’s classic Pediatric Neuroimaging, currently in its fourth edition and still going strong. After having read the impressive new opus, Pediatric Neuroradiology, by Tortori-Donati and Rossi, I may very well have to rethink that standard. In creating this textbook, Tortori-Donati and Rossi set out with the audacious goal of creating perhaps the most comprehensive and sweeping textbook on the subject of pediatric neuroimaging to date, and it appears as if they have done just that.

The 2-volume text spans 45 chapters and 1752 pages. The larger first volume, which accounts for more than two thirds of the book’s content, is devoted to imaging of the brain. The second volume covers imaging of the pediatric head, neck, and spine. Topics reviewed in the 27 chapters of the first volume include embryology of the brain, MR of the preterm infant brain, neonatal hypoxic-ischemic encephalopathy, vascular malformations (including a review of endovascular treatment), brain tumors, neurodegenerative disorders, the phakomatoses, and epilepsy. The last 5 chapters of volume 1 focus on state-of-the-art brain imaging techniques and feature in-depth and up-to-date discussions on MR spectroscopy; diffusion-weighted, perfusion-weighted, and functional MR imaging; brain sonography; and MR imaging of the fetal central nervous system.

The considerably shorter second volume is divided nearly evenly between head and neck imaging and spine imaging. Both parts begin with a chapter reviewing embryology and conclude with chapters covering sonographic applications in the head, neck, and spine (including chapters on prenatal sonography). Topics covered in the head and neck section include abnormalities of skull development, craniosynostoses, imaging of the orbits and temporal bones, sinonasal diseases, and cervicofacial vascular malformations. The section on spine imaging includes chapters on congenital malformations, spine and spinal cord tumors, infectious and inflammatory disorders, trauma, and arteriovenous shunts.

A considerable emphasis is placed on understanding imaging in the context of current knowledge about disease pathogenesis, which results in a richer understanding of several diseases that neuroradiologists see on a day-to-day basis. In addition, several topics that have in the past been dealt with superficially in other texts finally get much-deserved attention in this book. Hemolymphoproliferative diseases and treatment-related disorders, rare phakomatoses, pediatric sellar and suprasellar disorders, and spinal arteriovenous shunts are among the more esoteric topics that receive their own chapters. Thankfully, the authors do not allow themselves to become bogged down by excessive minutiae, which is a potential danger in writing a textbook of this scope. Although topics are discussed in exceptional detail within each chapter, none of the information seems superfluous.

The chapters follow a set format and are generally well organized. Within each chapter, sections and subsections are individually numbered. For example, the chapter on brain tumors (Chapter 10) includes discussions on intra-axial tumors and extra-axial tumors, labeled sections 10.2 and 10.3, respectively. The section on intra-axial tumors is further subdivided into subsections on tumors of the posterior cranial fossa (Section 10.2.1) and tumors of the cerebral hemispheres (Section 10.2.2), and so on. The first page of each chapter presents a table of contents, which lists the sections and subsections contained within and their respective page numbers, making it fairly easy to locate a specific topic within any given chapter.

Given the large number of contributing authors (57 to be exact) and the wide range of topics covered, one might expect to encounter significant variability in organization, content, and quality among each of the individual chapters, but I did not get this sense as I read the book, which is a testament to the editorial efforts of Tortori-Donati and Rossi. Not one of the chapters felt out of place or particularly lacking when held up against the others. This is not to say, however, that certain chapters do not stand out.

Perhaps the most impressive contribution to the textbook is the chapter on metabolic disorders by Dr Zoltán Patay, which spans 181 pages and could easily make up an entire textbook on its own. This chapter is among the most exhaustive reviews of metabolic brain disorder imaging I have come across, yet Patay’s treatment of the subject keeps the material interesting and accessible. The chapter is well organized, first presenting an overview of metabolic disease and describing a number of approaches to classifying metabolic disorders. This is followed by discussions on the use of various imaging modalities in metabolic disease work-ups, clinical and laboratory aspects of the disorders, and management. The last two thirds of the chapter are devoted to discussing individual metabolic disorders (more than 60 of them, in fact) and their imaging features. One section within the chapter that I found particularly useful provided a systematic approach to analyzing MR images in metabolic disorders, including a table of important structures to analyze and a list of specific disorders with suggestive or pathognomonic patterns on MR imaging. I suspect that this will be the first textbook I turn to the next time I encounter a complicated case of metabolic disease in a child.

Figure quality throughout the book is, for the most part, excellent, and a healthy number of photographs, schematic diagrams, and tables are included, which substantially enhance the readability of the text. Unfortunately, I encountered a smattering of errors while perusing the figure legends, including some mislabeled figure parts. Occasional figures might also have benefited from additional annotations (though this is an entirely subjective complaint). These are relatively minor squabbles, and for the first edition of a textbook of this scope, a few copyediting errors are to be expected. Hopefully these issues will be addressed in future editions.

The great depth and detail with which topics are discussed within this book can at times be overwhelming, particularly to the casual reader. This is not the first textbook I would reach for if I were in search of a few quick and easily digested facts about a specific disease entity, but it was not the authors’ intent for this to be such a book. There are a number of books in print that already serve that purpose. As such, this is probably not the ideal first textbook on pediatric neuroradiology for radiology residents, general radiologists, or even first-year neuroradiology fellows, though the book is written such that the material is certainly understandable at a basic level. As Tortori-Donati writes in his preface, the book is “deliberately encyclopedic,” and therein resides the true strength of Pediatric Neuroradiology. The amazing lengths to which Tortori-Donati and the contributing authors have gone to provide the most up-to-date and comprehensive information possible make this book an invaluable resource to those whose interest in pediatric neuroimaging extends well beyond surface comprehension. For pediatric neuroradiologists and neuroradiologists with a genuine enthusiasm for pediatric neuroimaging, I could not recommend this book more highly. Pediatric Neuroradiology is a most welcome addition to the existing canon of texts on the subject and one that I expect will withstand the test of time.