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Diagnostic ultrasound in neurology — Methods and techniques
435 Diagnostic Ultrasound in Neurology - - Methods and Techniques, b y M . S. T e n n e r a n d G. M. Wodraska, x +
183 pages, 168 i l l u s t r a t i o n s , 5 tables, J o h n W i l e y a n d S o n s ,
N e w Y o r k , L o n d o n , 1975, U S $ 31.10, £ 15.65. This book which is devoted to ultrasonic examination of the brain using a simple A Scan technique is a very meticulous and painstaking piece of work. The illustrations are well produced, the quality of paper and printing is extremely high. The authors undoubtedly possess a high degree of expertise in this method of examination and the book is obviously the culmination of many years of hard work. There are several points to be considered, however, before recommending its purchase. The first and probably the most important is that with the advent of computerised axial tomography and the extremely rapid advances which have been made the method that the authors are describing is probably obsolescent. Secondly, it would appear that some of the claims for the accuracy of ultrasonic diagnosis are somewhat extravagant. For example, on page 72 the criteria for the sonographic diagnosis of hydrocephalus are given, on page 74 diagnostic criteria for senile atrophy are given after the remark "characteristics of a sonogram diagnostic of senile atrophy". The inference is that the distinction between hydrocephalus from obstruction and hydrocephalus ex vacuo can be confidently and reliably made on the basis of an ultrasonic examination. No accuracy figures are given and no correlation with air encephalography or radio-active isotope scanning is made. There are interesting sections in the book on examination of the brain stem and examination of haematomas, subarachnoid haemorrhage, tumors etc. but unfortunately once again no figures for numerical accuracy are attempted. The third point to be considered is that even if ultrasonic examination does yield a high degree of accuracy in the hands of the authors it is very doubtful whether such a high degree of expertise could be readily acquired by the average neuroradiologist with a heavy load of routine work, even were he prepared to devote a considerable amount of time and effort to the method which many now consider to be very much inferior to computerised axial tomography, if not already pass6. A. Appleby
183 pages, 168 i l l u s t r a t i o n s , 5 tables, J o h n W i l e y a n d S o n s ,
N e w Y o r k , L o n d o n , 1975, U S $ 31.10, £ 15.65. This book which is devoted to ultrasonic examination of the brain using a simple A Scan technique is a very meticulous and painstaking piece of work. The illustrations are well produced, the quality of paper and printing is extremely high. The authors undoubtedly possess a high degree of expertise in this method of examination and the book is obviously the culmination of many years of hard work. There are several points to be considered, however, before recommending its purchase. The first and probably the most important is that with the advent of computerised axial tomography and the extremely rapid advances which have been made the method that the authors are describing is probably obsolescent. Secondly, it would appear that some of the claims for the accuracy of ultrasonic diagnosis are somewhat extravagant. For example, on page 72 the criteria for the sonographic diagnosis of hydrocephalus are given, on page 74 diagnostic criteria for senile atrophy are given after the remark "characteristics of a sonogram diagnostic of senile atrophy". The inference is that the distinction between hydrocephalus from obstruction and hydrocephalus ex vacuo can be confidently and reliably made on the basis of an ultrasonic examination. No accuracy figures are given and no correlation with air encephalography or radio-active isotope scanning is made. There are interesting sections in the book on examination of the brain stem and examination of haematomas, subarachnoid haemorrhage, tumors etc. but unfortunately once again no figures for numerical accuracy are attempted. The third point to be considered is that even if ultrasonic examination does yield a high degree of accuracy in the hands of the authors it is very doubtful whether such a high degree of expertise could be readily acquired by the average neuroradiologist with a heavy load of routine work, even were he prepared to devote a considerable amount of time and effort to the method which many now consider to be very much inferior to computerised axial tomography, if not already pass6. A. Appleby