Abstract
This is a beautiful book replete with wonderful images. Its title says what it is: an atlas—a pictorial essay with emphasis on imaging as opposed to management. However, some facets of management are also discussed.
The authors are obvious enthusiasts about their subject. In the preface, they describe the central nervous system (CNS) as the “most attractive and important organ.” They state their goal for the book to be the promotion of “easy understanding” of up-to-the-moment neuro-imaging, prenatal diagnosis of CNS abnormalities, and options for management in utero and after birth. This is a tall order in 142 pages, but the authors rise to the occasion.
The first chapter in the book is a very short background to the subject and discusses some of the difficulties in prenatal diagnosis of CNS abnormalities. These include the difficulties in predicting function from the structure of the brain and also distinguishing normal from abnormal in the face of subtle or borderline findings.
The next 6 chapters discuss brain anatomy and development, imaging technology and techniques, the normal CNS and development, hydrocephalus and ventriculomegaly, congenital abnormalities, and brain abnormalities acquired in utero.
The chapter on anatomy and development is also very brief but has some good illustrations that cover the areas of the brain most commonly affected by prenatally diagnosed CNS abnormalities. The postmortem magnetic resonance imaging (MRI) images of stillborn fetuses illustrate the dramatic changes in the fetal brain with gestational age. These images are, however, small, with as many as 80 sections on each plate, thereby somewhat limiting the detail that can be seen.
The chapter on technologies and techniques discusses very briefly transabdominal and transvaginal ultrasound, 3-dimensional ultrasound, and MRI. The use of gray-level histogram width to evaluate tissue characteristics is also discussed, although this is probably of less practical interest to most readers at this time.
Chapter 4, on normal fetal CNS anatomy, is a pictorial review. Some of the ultrasound images are very pale and a little small, again making it more difficult to see the details. However, the 3-dimensional ultrasound images of the fetal spine, the 2- and 3-dimensional ultrasound images of the fetal brain circulation, and the 3-dimensional volume extractions are excellent. There is also a magnetic resonance surface image of a fetal brain at 34 weeks that is quite stunning. The detail is so clear that it looks like a pathological specimen.
The next 2 chapters (chapters 5 and 6) were, for me, a joy and the best in the book. The images are generally of high quality, well labeled, and accompanied by informative legends. Many of them have pathological or postnatal images correlated with prenatal ultrasound and MRI. The highlights for me included the 1st-trimester 3-dimensional ultrasound of spina bifida, postnatal 3-dimensional reconstruction computed tomography of the spine and skull, and the prenatal MRI images.
I enjoyed this book and will continue to do so. I recommend the book to anyone with an interest in prenatal CNS abnormalities whether their background is in radiology, maternal fetal medicine, pathology, or even pediatrics. This book will leave the reader with an appreciation of the power of imaging technology and with a sense of the things yet to come.