Aygun N, Shah G, Gandhi D.  Pearls and Pitfalls in Head and Neck and Neuroimaging: Variants and Other Difficult Diagnoses. Cambridge University Press; 2014; 498 pgs. 1063 illustrations; $130.00.

The book Pearls and Pitfalls in Head and Neck and Neurimaging: Variants and Other Difficult Diagnoses seeks to evaluate and discuss some of the more difficult interpretative issues in neuroradiology. The authors (Drs. Aygun, Shah, and Gandhi) have selected 106 cases they have deemed to fall into this category of elusive cases. To this reviewer, many of the cases have been properly selected to demonstrate and explain difficulties in interpretation, while other cases would not ordinarily cause much confusion.

The authors have divided the book into 19 sections, each with well selected cases (from 2 to 17 in each section). The major subdivisions are: Brain (CV disease, demyelinating diseases, tumors, infections, metabolic/degenerative disorders, trauma, miscellaneous); Artifacts and Anatomic variations; Skull Base; Head and Neck (temporal bone, paranasal sinus, orbits, salivary glands, neck masses, thyroid/parathyroid neck vessels); Spine (bony spine, discs, spinal canal/contents). The authors have clearly tried to define those areas of neuroradiology that they feel are particularly bothersome.

The cases are, for the most part, well-chosen, and the remarks about each entity are short (1 page); with each containing the following subdivisions: imaging description, importance, typical clinical scenario, differential diagnosis, major teaching points, and references.

Here are some examples of the types of cases chosen where confusion may be present: pseudoprogression of glioblastomas, RCVS (Call-Fleming), cortical vein thrombosis, intracerebral cavernous malformation, the multiple appearances of osmotic demyelination, low-grade tumors, pineal region abnormalities, PRES (and its various forms), perineural spread, fungal vs. invasive sinusitis, orbital pseudotumor and the variations of this inflammatory process, parathyroid adenomas, degenerative changes of the vertebral body end plates vs. infection (discitis).

Given the highly visual nature of this book, the text is short (which is good for those needing a quick clarification), but it lacks an in-depth and necessary discussion of the points being made. For example (and there are many), why is there restricted diffusion in a neurodegenerative disease such as CJD? How are certain images generated? What was the technique/protocol used? The authors had obviously decided not to emphasize neuropathology or technical issues. To make any future edition more robust, the authors might wish to consider a section they could title “Easily Missed Diagnoses.” Here they would show and describe cases that can escape detection. After all, that is one of the major concerns for any radiologist facing cases to be dictated, and is often more of a pitfall than coming up with a differential diagnosis.

For the experienced neuroradiologist there is little that is new here; however, the book allows for a good review of the topics presented and provides reminders of important facts involving frequently encountered diseases. For those in training there is significant value in this book (for residents/fellows the book should be read cover-to-cover), and therefore, it is recommended for inclusion in a sectional library.