MRI of the Musculoskeletal System. Martin Vahlensiek, Harry K. Genant, and Maximilian Reiser (eds.), Thieme, New York, NY, U.S.A., 2000


Although magnetic resonance imaging (MRI) can no longer be described as a new medical imaging modality, it is still developing and finding ever more clinical applications. Indeed, improvements in scientific understanding, technological advances, and accumulated experience have led to its becoming an established method for the diagnostic evaluation of many conditions such as diseases of the musculoskeletal system, particularly spine and knee.

This book is a translation of the original German edition published in 1996 and aims to provide an overview of the application of MRI to the joints. Aside from the three editors, it has contributions from 15 other authors from Europe and the United States. Following an introductory chapter on the technology of MRI, there are nine chapters devoted to specific joints (spine, shoulder, elbow, wrist, hip and pelvis, knee, ankle and foot, temporomandibular joint, and sacroiliac joint), three devoted to specific tissues (muscle, bone marrow, and tumors), and one devoted to a disease (osteoporosis). There is also an appendix and a detailed index along with a wealth of high-quality tables and illustrations. Each chapter is supplemented with an extensive list of references.

The opening chapter goes much further than mere technology; it stands as a succinct introduction to the underlying science of MRI. Equipment (magnet, coils, etc.) is not described; rather the emphasis is on tissue properties (such as proton density and relaxation times) and how they can be utilized to provide image contrast under different radio frequency pulse sequences. Those new to these concepts may find this chapter a somewhat daunting introduction although the emphasis is always on clinical utility. For those interested in bone densitometry and other aspects of bone measurement, the short chapter on osteoporosis is rather disappointing; the quantification of relaxation times and trabecular architecture are only briefly discussed and the references are dated. The appendix is a collection of diverse topics: the investigation of swollen extremities, magic-angle phenomena, dedicated MRI systems, and suggested examination protocols for joints at low and high magnetic fields.

The chapters on the joints and tissues tend to follow the same pattern: introductory sections on anatomy and examination technique, detailed illustrated discussion of specific disorders, and concluding sections on pitfalls in scan interpretation and comparison with other imaging modalities. It is here that the strength of the book lies. The description of both imaging technique and image appearance is detailed and profusely illustrated with MRI scans and explanatory diagrams. X-ray computed tomography and radiographic images are included as necessary with an indication of those circumstances in which they may be superior to MRI. Attention is drawn to artifacts and other potential causes of misinterpretation and the authors emphasize not only those factors (such as particular pulse sequences and use of contrast agents) which are helpful but also those that do not contribute useful additional information. Phosphorus magnetic resonance spectroscopy is addressed in the chapter on muscle but the material is fairly general and concentrates on metabolism; there are no example spectra and again, the references end at 1995.

This is a beautifully produced book; in particular the quality of the image reproduction and the accompanying diagrams is excellent. It also reads very well, so much so that it is impossible to recognize that it was originally written in a language other than English; this is a great credit to Dr. Peter Winter who was responsible for the translation. However, to get the most from it, the reader needs to be familiar with the language of medical imaging generally and magnetic resonance in particular. A notable feature of both the body of the text and the legends to the tables and figures is the degree of detail (regarding pulse sequences, timings, concentration of contrast agent, etc.), which is yet independent of equipment manufacturer; this is commendable in a field where machine-specific acronyms abound. Typographical and other errors are rare although it was surprising to see a reference to free electrons (rather than protons) in a discussion of the image appearance of cortical bone. The references to some (but not all) chapters show additions up to 1999 which suggests that the opportunity has been taken to update at least a portion of the material at translation. However, in a subject which is continuously evolving, it is inevitable that some of the text is dated.

Clearly this is a book intended for a specialist readership interested in the diagnostic application of MRI to the musculoskeletal system. It is written by radiologists for radiologists although it can serve as a useful reference text for others involved in bone research.