Problem Solving in Musculoskeletal Imaging , by Dr William B. Morrison and Dr Timothy G. Sanders, is a text within the new Problem Solving in Radiology series by Elsevier. As the title suggests, the book centers on the challenges that face radiologists who interpret musculoskeletal studies, outlining practical solutions by some of the experts in the field.
The text totals 775 pages, split into four sections and further subdivided into 15 chapters. Section I, “Advanced Modalities: Protocols and Optimization,” consists of a single chapter that predominately focuses on magnetic resonance (MR) imaging. The chapter begins by briefly contrasting high-field and low-field MR scanners, followed by concise summaries of the premier MR sequences currently used in musculoskeletal imaging. Following these topics, the authors tackle the commonly encountered MR artifacts in musculoskeletal imaging, providing a description of each artifact, followed by preventive measures. Situations in which artifacts can be used to radiologists’ advantage are also highlighted, such as using the susceptibility artifact of a gradient-recalled echo sequence in a postoperative patient to “find the surgery.” Although this section is short, the included DVD provides additional related information, including suggested MR and computed tomographic protocols, printable patient questionnaires, and sample MR dictation templates.
Section II, “Procedures,” covers arthrography, joint injection, joint aspiration, and percutaneous biopsies. The authors illustrate the ideal techniques for common procedures such as shoulder or knee arthrography, as well as the preferred approach for less common requests, including pubic symphysis injections and metatarsal phalangeal joint arthrography. The chapter on musculoskeletal biopsies emphasizes preprocedural considerations, biopsy equipment options, and suggested techniques and approaches for various lesion types and locations.
The remaining sections make up the majority of the text, organizing the information by category in section III and by location in section IV. The broad categories of arthritis, infection, and neoplasm cover much of the commonly encountered musculoskeletal pathology. The authors accurately describe many classic disease presentations, for example, the erosive findings and joint predilection of chronic tophaceous gout. True to the title of the text, the authors do not shy away from the less clear cut scenarios, providing systematic approaches to cases in which diagnoses may be uncertain. For example, there is in an excellent discussion on differentiating tendinopathy from subtle partial thickness articular surface tears of the rotator cuff. Furthermore, there is considerable detail spent on the etiology of injuries. As an example, the mechanics behind the types (and subtypes) of femoral-acetabular impingement are featured.
Hundreds of quality images are provided to highlight the pertinent findings. The majority are clearly labeled MR images containing descriptive captions. Where helpful, the text incorporates illustrations, such as drawings of the types of perisoteal reactions in the chapter on tumors and tumorlike conditions. Boxes interspersed within the text further accent the important teaching points. All chapters conclude with suggested readings should more information be desired.
Overall, Problem Solving in Musculoskeletal Imaging is a collection of pertinent imaging procedures and pathology, representing a useful text for any radiologist involved in musculoskeletal interpretation. Hundreds of high-quality images illustrate the important findings, while the text emphasizes a systematic approach to the common and the complex scenarios that will no doubt arise in practice.
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