Abstract
ed M Hennerici and S Meairs Publisher: Cambridge: Cambridge University Press (2001) 428pp, price: £140.00, ISBN: 0 521 63223 4
This book reminded me of a large, old-fashioned family Christmas concert. The contributors (there are 56 of them) surely know one another very well. Each has his individual talent. There is a slightly competitive frisson. Each performance is well rehearsed and each party-piece is presented with polish and verve. The gentlemen perform, and the ladies listen perhaps, there being none amongst the authors. Excellent individually, the tension and discord only appears when taken as a whole - in the community singing as it were. In the presence of such individual talent the editor-conductors find that they cannot hold the choir in unison, and accept an untidy unity of rhythm within the separate voices.
The topic gives the book its unity. It is a wide-ranging exploration of the application of ultrasound to cerebrovascular physiology and pathology. Such is the dedicated enthusiasm of some authors to demonstrate their individual knowledge that on several occasions the text spills outside these limits, for example into discussions of lower limb vascular dynamics and cardiovascular pathology, or into examples of carotid angiography. These excursions serve well to place the majority of the text in context. This is divided into three sections. The first hundred or so pages are devoted to the physics and technology of ultrasound together with some chapters on haemodynamics. It is here that the reader first realizes the difficulties faced by the editors. There is much overlap of content, and the reader would find it necessary to read three separate chapters to gain an overview of the principles of Doppler techniques. Without dwelling on this point, it must be said that there is a fine line between redundant repetition, and the need to present knowledge from different perspectives in a multi-author book, and on several occasions the text could have been easily trimmed with no loss of content. The second and largest section, seventeen chapters extending over 200 pages, is headed Clinical Cerebrovascular Ultrasound. I think this heading is a little unfair, perhaps leading the reader to expect only a tutorial on how to carry out clinical studies in order to diagnose cerebrovascular disease. In fact each separate chapter draws on the specific interests of its own author, describing a range of techniques, some fairly routine but many semi-experimental, building on the experience and interests of a particular vascular laboratory. The disparate views of experts are particularly evident in places here, for example when setting out standardized methods for carotid evaluation. Dipping into these chapters the reader may find experimental studies in 3D flow patterns at the carotid bifurcation, a discussion of asymptomatic carotid stenosis, and a description of carotid artery pseudo-occlusion. Seven of the chapters review the developing area of transcranial Doppler, usefully relating MRI and angiographic images to the transcranial ultrasound studies, where these may be rather difficult to interpret. The high quality paper used enhances the grey-scale clarity both of the MR and x-ray images, and also of the numerous ultrasound images and histological sections with which the chapters are illustrated. The book concludes with a group of five chapters under the heading New and Future Developments. It is here that the text finally breaks with the repetition haunting the earlier pages, and each chapter in this section stands usefully on its own. Here the reader can find a concise review of contrast imaging, a description of ultrasonic thrombolysis, and an overview of emboli detection using multiple gated Doppler. Essential to the use of the volume is its extensive index, which has been prepared thoroughly and with care.
This is a book for the expert, not the novice. It assumes its reader to be active in cerebrovascular ultrasound, or in a laboratory devoted to vascular physiology. It expects the time and the mind to develop techniques and understanding using the expert experience in advanced laboratories around the world. It would be a worthy volume in an academic department library where innovation is part of the ethos. On the other hand I suspect that this book would be rarely taken down from the shelf of most vascular laboratories, where to be used and useful a book needs a more focused and coherent text than is contained here.