Hollenberg GM, Weinberg EP, Meyers SP. Differential Diagnosis in Musculoskeletal MRI. Thieme; 2015; 676 pp; $199.99
Differential Diagnosis in Musculoskeletal MRI was written with the goal of providing a simple reference book on the various pathologies encountered in a musculoskeletal radiology practice through an image-rich presentation of disease states and injuries. In this aim, the authors have succeeded, and should be applauded for the breadth of topics they were able to cover. The book is about 676 pages in length, but because the text is focused and organized into tables and the figures occupy many full pages, the volume reads much quicker than a standard text of similar size. The authors have organized the material into 12 chapters, with the first half of the book devoted to joint imaging (shoulder, elbow, wrist, hand, hip, knee, ankle, and foot), and the second half covering bone and soft tissue tumors and tumor-like conditions. Unfortunately for readers of this journal, there is no dedicated spine chapter, although spine MRI examples play a prominent role in the illustration of hematopoietic disorders/red marrow conversion.
The focus of this book is really on MRI findings—there is little detail on clinical presentation or considerations of surgical management. Radiographs and CT are infrequently depicted, except in the chapter on bone tumors. Some readers may feel that the images are too small in some cases to optimally highlight the intended pathology, and in certain instances the educational value might have been enhanced by more robust cropping (eg, depictions of superior labral tears and “turf toe” injuries. However, because this book is primarily aimed at trainees, providing enough surrounding anatomy is important so that the scale of the abnormality (often miniscule in MSK) is properly appreciated.
The joint chapters are straightforward in terms of organization and depiction of pathology. The level of detail is appropriate for radiology residents and those in the early months of a dedicated MSK fellowship. For example, there is a nice, concise treatment of the topic of instability lesions of the shoulder: Bankart, Perthes, ALPSA (anterior labral periosteal sleeve avulsion), GLAD (glenolabral articular disruption), and HAGL (humeral avulsion of the glenohumeral ligament), which are frequently confused by those early in training. There is a discussion of pulley injuries in the finger, but finer points of finger tendon injuries (eg, sagittal bands, check rein ligaments, etc) are left to more thorough, specialized texts. The tumor chapters are, relative to their clinical frequency, somewhat over-represented for an introductory text, but this is a strength that adds tremendous value for the trainee who needs to be able to generate a differential diagnosis quickly and accurately.
There are some issues with the organization of the text that I found frustrating. For example, residents and fellows are often asked to determine whether an exam shows osteomyelitis after hours or on call; however, there is no dedicated section for imaging of infection. Cases of osteomyelitis are presented in the hand and foot chapters, and in the bone tumor chapter, but the text would benefit from inclusion of several cases where cellulitis and other inflammatory changes are present while osteomyelitis is not. Tumors of bone are grouped by patterns of involvement (eg, intramedullary lesions expanding intact cortical margins, intramedullary lesions with cortical destruction, intramedullary lesions with well-circumscribed margins, etc.). This leads to some redundancy of tumor histologies—giant cell tumor of bone is covered in sections 10.3 through 10.8—and repetition of some images. And I have reservations about their use of the term “atypical lipomas” in describing what are better termed lipoma variants—eg, chondro-osseous and spindle cell lipomas—given the potential for confusion with atypical lipomatous tumors, which are histologically well-differentiated liposarcomas and should be called as such only when located deep in the trunk.
Despite these criticisms, I enthusiastically endorse Differential Diagnosis in Musculoskeletal MRI as a handy reference to use on a daily basis, particularly when teaching. It is a book to be “well-thumbed”, as the authors hoped in their preface, and I can easily envision going to it as an authoritative alternative to scouring the web for cases to compare with the one staring at you from the workstation.
