- Email: [email protected]
MR cholangiopancreatography, techniques, results and clinical indications
Book reviews
radiation effects, radiobiology, patient doses and biological effects of ultrasound, high frequency R F and magnetic fields would seem to be useful. The first exam on the fundamentals in imaging is also a good chance to acquire basic knowledge in that respect. Courses or exams on radiation protection and biological effects of the radiation types involved here are quite often taken much later if at all. Inevitably legal aspects in radiation protection are dealt with reference to British regulations. Chapters on imaging with ultrasound and magnetic resonance tomography complete the spectrum of modalities. M R I fundamentals and imaging concepts are complex and experience has shown that this matter is harder to get at and to teach than with the other subjects. Even so the fundamentals are shown concise but complete up to the basic pulse sequences. Brevity means here certainly that the reader has to go carefully through the chapter to get the full picture. Parameters relevant to quality assurance are briefly discussed in each chapter, protocols and measurement procedures are left out. The book covers the physical basics in imaging in a concise but comprehensive manner. The authors do not present or compare individual commercial products and solutions but rather help in the understanding of the underlying principles. Formulas are kept to an absolute minimum in number and use hardly ever symbols. Each chapter is completed with a number of questions; to aid in their treatment a cross-reference on relevant paragraphs is available at the end. This book provides a concise reference source for the physical principles in imaging for the medical profession and can be highly recommended as a good basis for the radiologist to prepare for the physics part of a board examination.
R. Nowotny Wien, Austria P[! S0720-048
X(97)00035
-1
MR cholangiopancreatography, Techniques, Results and Clinical Indications P. Pavone, R. Passariello (editors), Springer-Verlag, Berlin; 1997; ISBN 3-540-61349-8 As stated in the foreword, the emergence of M R cholangiopancreatography (MRCP) from experimental studies in the early 1990s to an important imaging tool in clinical practice has been one of the success stories in recent M R history. Drs Pavone and Passariello have undertaken the task to compile the experience that has been gained with M R C P in the past
163
few years. The book is divided into 11 sections and three appendices. Section one is entitled 'Imaging Technique' and describes extensively the various M R imaging techniques that have been used for visualization of the bile ducts and it gives a nice overview of the imaging parameters used by different study groups. The advantages and disadvantages of each technique are explained on a level which can be understood by any radiologist and not only by a physicist. In sections two and three the anatomy and congenital malformations of the biliary tract are described. Sections four, five and six are entitled ' M R Cholangiography in Evaluation of the Jaundiced Patient', 'Biliary Stone Detection by M R Cholangiography' and ' M R Cholangiography in Benign Biliary Stenoses'. The role of M R C P in the detection of bile duct stones is shown in several examples. Fortunately, not only the 3D-MIP reconstruction images are shown, but also the corresponding source images are printed to illustrate the importance of thin-slice source images. In section six, however, the role of M R C P in differentiation of 'phlogistic' (fibrotic) and functional stenoses of the papilla is somewhat overstated. In clinical practice, these two conditions are rarely separated by the gastroenterologist, and sphincterotomy is performed anyway. Moreover, the list of references in section six suffers from some inaccuracies and repetitions. Sections seven and eight about neoplasms obstructing the bile ducts and M R pancreatography are very informative. One of the major advantages of M R C P over diagnostic ERCP, i.e. to complement the examination by acquisition of T1- and T2-weighted images of the surrounding parenchyma, is demonstrated in several examples. One of the drawbacks of the section on the pancreas is the omission of congenital anomalies such as pancreas divisum, a condition where E R C P often fails and M R C P has emerged as the imaging modality to depict pancreatic duct obstruction. In section 11, the residual role of ERCP in the era of M R C P is described on a fair basis. In the appendices an outlook into the bright future of M R C P in the age of laparoscopic cholecystectomy is given. In summary, the book has an easy-to-read text accompanied by a collection of excellent images, which makes it well worth its price. It is highly recommended for the abdominal radiologist and gastroenterologists interested in pancreatico-biliary imaging.
Wolfgang Schima Vienna, Austria PIZSO720-O48X(97)OOO34-X
radiation effects, radiobiology, patient doses and biological effects of ultrasound, high frequency R F and magnetic fields would seem to be useful. The first exam on the fundamentals in imaging is also a good chance to acquire basic knowledge in that respect. Courses or exams on radiation protection and biological effects of the radiation types involved here are quite often taken much later if at all. Inevitably legal aspects in radiation protection are dealt with reference to British regulations. Chapters on imaging with ultrasound and magnetic resonance tomography complete the spectrum of modalities. M R I fundamentals and imaging concepts are complex and experience has shown that this matter is harder to get at and to teach than with the other subjects. Even so the fundamentals are shown concise but complete up to the basic pulse sequences. Brevity means here certainly that the reader has to go carefully through the chapter to get the full picture. Parameters relevant to quality assurance are briefly discussed in each chapter, protocols and measurement procedures are left out. The book covers the physical basics in imaging in a concise but comprehensive manner. The authors do not present or compare individual commercial products and solutions but rather help in the understanding of the underlying principles. Formulas are kept to an absolute minimum in number and use hardly ever symbols. Each chapter is completed with a number of questions; to aid in their treatment a cross-reference on relevant paragraphs is available at the end. This book provides a concise reference source for the physical principles in imaging for the medical profession and can be highly recommended as a good basis for the radiologist to prepare for the physics part of a board examination.
R. Nowotny Wien, Austria P[! S0720-048
X(97)00035
-1
MR cholangiopancreatography, Techniques, Results and Clinical Indications P. Pavone, R. Passariello (editors), Springer-Verlag, Berlin; 1997; ISBN 3-540-61349-8 As stated in the foreword, the emergence of M R cholangiopancreatography (MRCP) from experimental studies in the early 1990s to an important imaging tool in clinical practice has been one of the success stories in recent M R history. Drs Pavone and Passariello have undertaken the task to compile the experience that has been gained with M R C P in the past
163
few years. The book is divided into 11 sections and three appendices. Section one is entitled 'Imaging Technique' and describes extensively the various M R imaging techniques that have been used for visualization of the bile ducts and it gives a nice overview of the imaging parameters used by different study groups. The advantages and disadvantages of each technique are explained on a level which can be understood by any radiologist and not only by a physicist. In sections two and three the anatomy and congenital malformations of the biliary tract are described. Sections four, five and six are entitled ' M R Cholangiography in Evaluation of the Jaundiced Patient', 'Biliary Stone Detection by M R Cholangiography' and ' M R Cholangiography in Benign Biliary Stenoses'. The role of M R C P in the detection of bile duct stones is shown in several examples. Fortunately, not only the 3D-MIP reconstruction images are shown, but also the corresponding source images are printed to illustrate the importance of thin-slice source images. In section six, however, the role of M R C P in differentiation of 'phlogistic' (fibrotic) and functional stenoses of the papilla is somewhat overstated. In clinical practice, these two conditions are rarely separated by the gastroenterologist, and sphincterotomy is performed anyway. Moreover, the list of references in section six suffers from some inaccuracies and repetitions. Sections seven and eight about neoplasms obstructing the bile ducts and M R pancreatography are very informative. One of the major advantages of M R C P over diagnostic ERCP, i.e. to complement the examination by acquisition of T1- and T2-weighted images of the surrounding parenchyma, is demonstrated in several examples. One of the drawbacks of the section on the pancreas is the omission of congenital anomalies such as pancreas divisum, a condition where E R C P often fails and M R C P has emerged as the imaging modality to depict pancreatic duct obstruction. In section 11, the residual role of ERCP in the era of M R C P is described on a fair basis. In the appendices an outlook into the bright future of M R C P in the age of laparoscopic cholecystectomy is given. In summary, the book has an easy-to-read text accompanied by a collection of excellent images, which makes it well worth its price. It is highly recommended for the abdominal radiologist and gastroenterologists interested in pancreatico-biliary imaging.
Wolfgang Schima Vienna, Austria PIZSO720-O48X(97)OOO34-X