Mukherji SK (Cons. Ed.), da Cruz Jr. (Guest Ed.) Neuroimaging Clinics of North America: Clinical Applications of Diffusion Imaging of the Brain. Vol. 21, No. 1. February 2011, Theclinics.com, pages 1-196, 12-month subscription $314.00.
With Diffusion Imaging now accepted as part of a routine brain imaging it is important to realize its full potential and the implications of its use. The newest issue of the Neuroimaging Clinic of North America, edited by Dr. L. Celso Hygino da Cruz, contains 9 chapters which summarize the current statics of DWI in various clinical situations involving the brain. These include DWI in brain, ischemic stroke, multiple sclerosis, infection, trauma, and neonatal conditions. There is, in addition, an entire chapter on the basic principles of DWI in which there is a combination of the theories concerning the derivatives of diffusion imaging. Insights into the method for such entities as tractography (including deterministic tractography, probabilistic tractography, QBI based tractography). A list of abbreviations and their definitions would have helped in this chapter.
The chapter on DWI in brain tumor assessment contains good images which are basically standard for this subject; the only issue involves postoperative imaging with DWI, where areas of restricted diffusion are termed tumor recurrence and the possibility of ischemia/inflation around the restricted tumor bed is not mentioned. In stroke, specifically acute ischemic stroke, the information in this chapter is probably the most important in the book. There is an excellent summary of the trials for IV and IA therapy that emphasizes the 20% perfusion/diffusion mismatch. Additional information beside diffusion includes vascular imaging and the predicators for which patients may develop hemorrhage post treatment; included is an algorithm for acute ischemic stroke working workup. This AIS is to the reviewer the most valuable chapter in the book. With multiple sclerosis, diffusion is shown in different stages of the disease, and in the chapter on infection the expected but well demonstrated viral/bacterial changes are shown, as well as the difference between pyogenic and fungal infections with DWI, along with changes in parasitic infections (e.g. toxoplasmosis) and the various evolving forms of cysticercosis. Although the role of DWI in traumatic brain injury is not usually a critical matter, the authors do show and discuss examples of its occasional usefulness—for instance, in abnormal DTI/FA when the routine imaging would not suggest regional abnormalities, or in relatively subtle DAI on routine imaging where the DWI findings are clear cut.
It is in neonates where DWI can be of great importance because of the often confusing signal changes as the brain matures. Beautiful and highly instructive images stress the point of the value of diffusion imaging in the newborn and young infants. We see how DWI can more easily uncover HII in areas where routine imaging may not be as striking, visualize white matter lesions of prematurity, show obvious germinal matrix hemorrhage, demonstrate subtle imaging changes in hypoglycemia and changes in arterial stroke/venous thrombosis. Along with these abnormalities more obscure white matter and gray matter metabolic abnormalities such as citrullinemia or sulfide oxidase deficiency are shown. A final chapter shows how DWI is used to monitor disease progression.
This is a valuable volume in the Neuroimaging Clinics of North America series, and its purchase as part of the ongoing Clinics is recommended.
