Griffiths PD, Morris J, Larroche JC, et al. Atlas of Fetal and Postnatal Brain MR Imaging. ELSEVIER SAUNDERS 2010, 272 pages, $159.00.
Fetal and Postnatal Brain MR Imaging is a comprehensive atlas on normal fetal and neonatal brain development. Brain development is an extremely complicated process which makes interpretation of fetal and neonatal anomalies an extremely challenging process. Imaging of the fetal brain in particular has gained importance in the past decade for diagnostic, prognostic and, more recently, for therapeutic reasons. In some countries, post natal MRI is even being considered as an adjunct to post mortem autopsy. Given the need for accurate interpretation of fetal and early post natal MR pathology, this Atlas serves as an extremely valuable resource for understanding normal MR appearances of the brain from the second half of pregnancy to 18 months postnatally.
The team of authors is led by Dr. Paul Griffiths, who is a renowned expert in the field of Fetal and Neonatal imaging. The atlas is divided into 3 main sections, with the first section describing the surface anatomy of the brain, both fetal and postnatal. Gross specimens are used to correlate with the imaging findings (in sections 2 and 3) as well as to help better understand fissural anatomy. Section 2 has images from six gestation age periods ranging from 19 to 37 weeks. The authors have depicted these images in a nice format which has the in-utero fetal MR image and the post mortem fetal MR image matched as closely as possible to the corresponding histologic specimen and line diagrams. Histologic specimens and line diagrams have been used from the reference book Development of the Human Fetal Brain: An Anatomical Atlas by Reeves Higgins and Larroche, which was published more than 20 years ago. Personally, I have always been fascinated by the germinal matrix and, in my opinion, there is no text which demonstrates the evolution of this structure better.
Section 3 has T1- and T2-weighted MR images in the axial, coronal, and sagittal planes showing the images of the brain in six different periods from birth until 18 months following gestation. Corresponding line diagrams are provided. This part of the atlas is useful not only in understanding the neonatal anatomy of the brain but also the normal myelination pattern, knowledge of which is extremely important while interpreting postnatal brain MR’s to help differentiate normal anatomy from pathology.
The caveats of this book are few, if any. The most obvious problem, which the authors have alluded to as well, is that the fetal and post natal MR’s and the histologic specimens have been obtained from different individuals. So, therefore, the scans and the specimens are not exact matches. Also, it would have been nice if there was text describing the myelinated areas in each postnatal MR image, which is very helpful when reviewing incompletely myelinated brains. There is, however, a chart at the beginning of section 3 which serves as a nice checklist for normal myelination of different structures in the brain, based on the postnatal age of the patient.
Overall, this is an excellent atlas with high-resolution MR images and age-matched histologic sections and line diagrams of the brain describing the fetal and neonatal periods. This is probably the most comprehensive text on this subject currently in print. This Atlas can serve as an excellent reference book not only for neonatologists and pediatricians but also for radiologists who read fetal MRI’s, particularly pediatric neuroradiologists.
