Brain Imaging: Case Review Series

doi:10.3174/ajnr.A1608

L.A. Loevner. Mosby Elsevier; 2008, 288 pages, $49.95.

Case-based review books are increasingly popular, explained by the recognized need to continually quiz oneself for Board Certification/Certificate of Added Qualifications/Maintenance of Certification and because these books tend to be more fun than plowing through a textbook. To be effective, such a book must be challenging to all degrees of expertise—from resident to fellow to practicing neuroradiologist/attending level. Brain Imaging: Case Review Series written entirely by Laurie Loevner is constructed like others in this series in the past—–straightforward cases (“Opening Round”) first, followed by increasingly challenging cases under “Fair Game and Challenge.” To this extent, Dr Loevner has succeeded in providing readers at all levels an adequate amount of material (200 cases) with reasonable questions for each case. Parenthetically, one does have to wonder how long such quiz books can survive given the amount of nearly equivalent material on the Web.

The format in this book is familiar to most readers—that is, anywhere from 2 to 4 images are shown and underneath that montage are 4 questions dealing with the images and the presumed diagnosis. On the next page, the diagnosis is given and brief answers are supplied related to each question. The problem with the material presented is not in the choice of cases, but that in many instances, the images themselves are not described. While for the experienced neuroradiologist, one could argue that the findings are so obvious that neither the description nor the labeling of the pertinent findings is necessary, this reviewer would disagree because the book is aimed at all levels of expertise. The omission would leave the relatively inexperienced resident wondering what the major findings are. Also more subtle findings are never labeled. After the quiz presentation, a half page in which the findings are described and labeled should have been added. A few examples (just a few—there are many similar ones) will suffice to point out such issues. In the case of a pyogenic abscess, it would seem logical (as a teaching point) on a following page to indicate the diffusion-weighted image and the apparent diffusion coefficient and label the findings. There are also images included that are never described in the text, such as a lumbar spine segmentation anomaly in an Arnold-Chair malformation.

In a case of a pineal cyst, the author describes “pituitary” apoplexy; it is not clear whether this was an attempt to draw an analogy between true pituitary apoplexy and a bleed into a pineal cyst or whether this was simply a mistake. Some points are left undescribed—so when the author says that “not all brain abscess have restricted diffusion,” no mention is made of the types of brain abscesses that have no restricted diffusion; or in a case of diffuse cerebral edema in a child with nonaccidental trauma, the author never states what the images show.

If such misgivings are put aside, the book does offer a good self-test. I suspect that many will look at the cases, suggest a diagnosis, answer the questions, then read the diagnosis and answers to the questions, and skip the couple of paragraphs written about the case, assuming that they got the correct answer. That would be a mistake because there is good information in the brief narratives.

This Brain Imaging: Case Review Series would make a decent addition to a departmental library, where residents studying for the Boards could use it as a quick test of their knowledge.