Waldt S, Eiber M, Woertler. Measurements and Classifications in Musculoskeletal Radiology. Thieme; 2013; 224 pgs.; 423 illustrations; $129.99.
Measurements and Classifications in Musculoskeletal Radiology is a relatively slim 224-page reference text for key measurements in MSK imaging. The book is organized into 17 chapters, each covering topics ranging from joint anatomy, tumor classification, grading of cartilage and muscle injuries, and, most relevant to readers of AJNR, important measurements used in exams of the spine and craniocervical junction. The authors’ goal is to provide “a handy reference for everyday use” that covers a variety of measurement schemes and classifications commonly used in orthopedics (excluding fractures). In tackling this formidable task, the authors have utilized 423 illustrations and focused on the most clinically relevant classification systems in a layout that is well-organized and text that is to-the-point. I found myself frequently reaching for this book at the work station to teach residents and students, or to remind myself, of the myriad measurement techniques and classification systems used in orthopedic imaging. In this review, special focus will be given to the 2 chapters on spine imaging, which are most pertinent to a neuroradiology audience.
Chapter 8, “Spine,” contains 21 pages of text, images, diagrams, and tables that concisely review the key measurements used in spine imaging, with particular emphasis on radiographic assessment. The first half of the chapter focuses on curves of the spine, and outlines several different methods for measuring scoliosis. Because of the complexity of descriptors used for spinal curvatures, this section appropriately utilizes multiple diagrams and tables to summarize the classification schemes. Next, the authors address how to measure and grade spondylolisthesis, starting with the familiar Meyerding classification, and include a brief discussion of the Taillard method of “anterior displacement” as well as the technique proposed by Laurent and Eniola. Other topics discussed in the chapter are measurements of interpedicular distance, including tables for normal age-dependent values, and a summary of the nomenclature endorsed by the American Society of Neuroradiology for degenerative disc changes. Drawings are used to illustrate the different types of disc pathology (bulges and herniations) and the anatomic zones in which they occur. True to its spirit as a reference text, though, clinical MRI examples of various disc bulges or herniations are absent.
Chapter 9, “Craniocervical Junction and Cervical Spine,” is a bantamweight 7-page summary of the often difficult-to-remember constellation of lines and intervals that define radiographic abnormality at the atlanto-occipital and atlanto-axial junction and in the lower cervical spine (using Panjabi and White criteria). Despite its brevity, it contains a sufficient level of detail for basic analysis of vertebral alignment and stability on cervical spine radiographs, assessment of basilar impression, and measurement of prevertebral soft-tissue thickening. While no longer as important in the modern hospital setting, given the ubiquity of CT, this chapter nonetheless provides a convenient one-stop reference for constructing and measuring the best-known lines and intervals, and would be particularly helpful for residents embarking on their early neuroradiology rotations.
The remaining chapters of the book are structured similarly to the two described above, and cover lower limb alignment, all major joints (hip, knee, foot, shoulder, elbow, wrist, and hand), as well as grading/staging of bone and soft tissue tumors, articular cartilage lesions, rheumatoid arthritis, hemophilia, muscle injuries, and skeletal age. (As an aside, the 2 pages comprising Chapter 11, “Osteoporosis,” include a basic overview of osteoporotic vertebral compression fractures.) It should be emphasized that not just bony anatomy but classifications of soft tissue injuries (eg, meniscus, labral, and rotator cuff tear types) are included. Key points, clinical pearls, and pitfall alerts are usefully highlighted in gray boxes marked with an exclamation point throughout the text. Because literature references are often made to the original primary sources, they are necessarily dated but no less relevant. The only miscue was their nonstandard definition of patella alta as a ratio <0.8; while not strictly incorrect based on their defined equation for the ratio, using the reciprocal of the normal Insall-Salvati ratio is unnecessarily confusing. This rare miss, however, should not detract from the overall superior quality of the book’s content.
In summary, the authors should be commended for their efforts in coalescing the various classification schemes used in orthopedics into a single, digestible volume that highlights the classic pathoanatomy encountered on a daily basis in musculoskeletal radiology. In the few weeks since receiving it, I have already found it an incredibly helpful tool both for myself and for educating both junior and senior residents. While not intended for subspecialists in neuroradiology, it contains most of the pertinent measurement techniques and classifications used in basic assessment of spine radiographs. Slim but dense with information, Measurements and Classifications in Musculoskeletal Radiology deserves a place in all musculoskeletal work areas and resident libraries.
