Law M, Som PM, Naidich TP.  Problem Solving in Neuroradiology. Mosby Elsevier, 2011, 655 pages, $149.00.

To instill the Socratic method of teaching in a neuroradiology textbook is an interesting approach to education. Drs. Law, Som and Naidich—along with 35 co-authors—have put together a “problem solving” textbook, with questions embedded in many, but not all, chapters. When used, it focuses the reader’s attention to the material in the chapters. As with many books these days, the entire text is searchable online when you activate your account with a code unique to each book.

The book is divided into 4 sections: 1) Advanced Modalities: Protocols/Optimization, 2) Procedures, 3) Problem Solving in Various Disease Categories, 4) Problem Solving in Various Anatomic Regions.

In the section on Advanced Modalities the chapters are multi-detector CT, MRI Advanced techniques, and PET/CT. The intent is to describe how each of these modalities is used as a problem solving tool. The CT chapter begins as basically a survey of uses in various disorders, but then drills down to some of the more critical issues such as CT perfusion and how this can be used in situations of cerebral ischemia. A few excellent examples are shown where one sees the relationship between CT and MR in ischemia or where infarct evolution is seen. The image quality in this chapter, as is true throughout the book, is of high quality. This first chapter provides examples of the power of CT across the breadth of neuroradiology and how the application of different algorithms or techniques (e.g. curved reformats bone, kernels, etc.) is used. A number of examples ranging from brain, spine, temporal bone orbit pathology provide a pictorial survey of CT’s strength. The chapter ends with an important section related to multi-detector CT—in particular its current status relative to resolution, dual energy CT, flat panel volume CT, and the use of portable CTs.  A nice graph is included which shows the developmental changes of CT over the past 4 decades. The advances from axial head CT to body imaging to spiral/helical CT to MDCT and now to dual source, flat panel, dual-energy CT makes one wonder how this graph (with multiple sprouting lines) will look in another 10 to 20 years.

While a review of each chapter cannot be part of an overall and reasonably concise evaluation of a book, a few sample chapters selected at random in addition to the CT chapter mentioned above will suffice. In chapter 9 (Infection/Inflammation), the authors start by highlighting basic clinical information in a number of areas such as meningitis and empyemas. This chapter is basically a cursory survey of brain infections. It only briefly illustrates and describes the full potential of MRS in these multiple etiologies. An opportunity was missed to show the spectroscopic findings, for example, in tuberculomas, or to show the amino acid presence in an anaerobic infection. Missing from this chapter are posed questions (such are present, however, in other chapters) which could have been effective in teaching and raising some controversial issues. If the authors plan a new edition of this book, it would be well to assure the inclusion of such questions as seen in the chapters on Brain Trauma, Metabolic Disorders, or Brain Tumors. Despite the good quality of the images, opportunity was also missed in this chapter to illustrate some of the not uncommon entities such as gelatinous pseudocyst or immune reconstruction inflammation. In this chapter, as in others, the references are not specifically cited; they are only given as “suggested readings”. This clearly was easier for authors of all the Chapters but makes looking up any article directly related to a statement in the book more difficult for the reader.

Contrary to the brain infection chapter, other chapters do directly address the issue of problem solving, which was the book’s primary premise. A prime example (there are others) is the chapter on PET/CT Imaging Squamous Cell Carcinoma of the Head and Neck. Here the authors—on page after page—pose questions of concern and then proceed to answer them, such as in the following examples:

• Does FDG PET/CT have a primary role in the evaluation of lymph node metastasis?
• What are the challenges of lymphoid hyperplasia in lymph node classification?
• What is FDG PET’s role in carcinoma of an unknown primary?

As in other chapters like the one on Metabolic Disorders, excellent questions (and, of course, answers) are present.

This book contains excellent images and the premise on which it is written is strong—i.e. to answer questions which are sometimes troubling. It is a premise which, however, is not followed in every chapter. The book is recommended since it can serve as a good guide for neuroradiologists in training and for those in practice who wish a reasonable survey of our field.