Lane J, Witte RJ. The Temporal Bone: An Imaging Atlas. Springer 2010, 109 pages, 53 illustrations $ 129.00.
The Temporal Bone: An Imaging Atlas provides well labeled sectional images through the temporal bone using both CT and MRI. The subject is very well covered and accurately detailed. There is little text; the images are the heart of this book. There are many atlases in many books available today. What is unique about this effort is the method used to create the images as well as the quality and detail of the figures. The authors use micro CT and micro MRI to give higher resolution than is currently possible with clinically available scanners. There are very few drawings or diagrams. Rather the authors create three dimensional reformatted images from these higher resolution data sets and then use them to point out the intricacies of the fine anatomy of one of the most complex structures in the human body.
The authors begin with micro-computed tomography capable of a 20 micrometer voxel size as well as a 9.4 Tesla micro MRI. A temporal bone specimen was scanned using these higher resolution systems. The superbly detailed images show not only the bony anatomy familiar to radiologists dealing with the temporal bone but also some of the finer detailed soft tissue anatomy including parts of the membranous labyrinth. The authors took the additional step of “flooding” the spaces of the middle ear for the MRI so that the small bony structures would be contrasted against high signal rather than lost within the usual signal void of the air. The data sets were then digitally manipulated on a work station to provide absolutely amazing three dimensional images. The finer detail of the higher resolution images allows visualization of structures that previously had been displayed only with drawings. Many of the three dimensional images are presented in the standard perspectives used by anatomic artists to demonstrate some of the more intricate aspects of the anatomy. However, unlike the drawings previously available, these images are actually derived from the objective data sets provided by imaging technology. There is no subjective interpretation. We are looking at actual imaging studies.
The book is presented as five chapters. The first chapter is a “material and methods” section that describes the various techniques used in creating the images for the book. This chapter is simply an introduction to chapters two and three. Chapters Two and Three are the central focus of the book. Chapter Two presents the three dimensional reformatted images. The authors show the fine bony detail primarily from the CT data set and the fine structure of the labyrinth from the MRI. Further they combine or merge the two data sets to show the relationships of the bone and soft tissues. Chapter Three shows the sectional images. Each plate is presented in four parts. The micro CT and the micro MR through a specific planar section are matched with similar sections taken with modern equipment currently available in clinical practice. This again provides a unique perspective. The structures seen every day by the reader are clearly labeled in the images from the clinical machine but the same figure shows the reader the more highly detailed sectional image from the micro CT and MRI. This method gives a better understanding of the relationships of the various structures and is an excellent learning tool for a student seeking to understand the temporal bone. The routine axial and coronal planes are presented but there are also labeled images in the various oblique planes that many neuroradiologists are beginning to favor for specific clinical applications. The chapter also provides a preview of what we will almost certainly be seeing in the near future as technology develops and companies build units with higher and higher resolution.
At first it seemed a bit odd that the three dimensional images were presented before the planar sections. In diagnostic imaging, we most frequently think of the three dimensional images as a reconstruction or reformat done as a secondary exercise that comes after the primary examination of sectional images. However, the order of this book seems to create a programmed learning tool. Once the student is familiar with the organization and relationships of the various structures shown in three dimensions, the sectional images are less confusing and are easier to comprehend. This is a great way to learn the anatomy.
Chapter Four is an interesting addition. The authors present various clinical situations where the higher resolution technology might have a direct benefit. The high resolution images from chapter two and three were obtained from cadaver specimens. The authors don’t have clinical cases using these higher resolution images but they do show clinical cases on modern clinical scanners with the abnormality next to a higher resolution specimen image in the same plane. This gives the reader a sense of the advantage that might come from the next generation of technology.
Finally there is a fifth chapter that is simply an introduction to a CD inserted into the back cover of the book. The CD has a program where the viewer can look at the images from the book on their personal computer. By clicking on a point in one plane, the program shows the same point in other planes and the relationship to a three dimensional image. This would be very helpful to any student trying to explore the intricate complexities of the temporal bone anatomy.
I would definitely recommend this book to anyone that has any involvement in temporal bone imaging. Neuroradiologists, otolaryngologists, and neurosurgeons would all benefit. The most advanced neuroradiologist can see the anatomy with slightly higher resolution to gain a better understanding of the relationships of one structure to another. The beginning resident or even medical student can use the book as an introduction to temporal bone imaging. The imaging technologist would certainly benefit from the book also. Not only will the book help in understanding the anatomy of the temporal bone, but it can also serve as an excellent guide to the precise angles and planes routinely required by today’s imaging.
This book is all about the images, and the images in this book are truly remarkable. I would give the book very high marks and a definite recommendation.
