Neuroimaging Clinics of North America. Ophthalmology Imaging.

American Journal of Neuroradiology

Edited by Mahomood F. Mafee. Volume 15, Number 1, February 2005

Imaging of the globes and orbits is a highly specialized skill. For an area so small, a disturbingly large variety of lesions can occur, and, though many of the lesions are typical, occurring frequently and with reasonably characteristic imaging features, others are sufficiently infrequent and/or bizarre that radiologists may find themselves baffled and reaching frantically for some type of reference book. This fact alone justifies the need for a practical reference work on ocular and orbital imaging. Dr. Mafee has endeavored to do just that in this volume of Neuroimaging Clinics. I do not believe that the goal here, in the Clinics format, was to produce a comprehensive text.

Dr. Mafee has called upon his colleagues, including some very well-known leaders in the field as well as many more junior scholars, and put together a group of articles including orbital imaging at high field, anatomy and pathology of the eye with CT and MR imaging, chapters dedicated to the optic nerve, the sellar/parasellar area, the lacrimal drainage system, and chapters dealing with certain common ocular/orbital lesions such as retinoblastoma and vascular lesions in children, cavernous hemangioma, and orbital schwannoma/neurofibroma. Some less common conditions are also given dedicated chapters, such as medulloepithelioma of the ciliary body (which I never have heard of) and orbital rhabdomyosarcoma.

The first chapter, which includes imaging the orbit at 3T, sets forth the advantages and disadvantages of such imaging and provides examples of many common lesions imaged at 3T; however—and this is the case throughout the book—many of the images are too small, and, though the lesions are visible, they are sometimes hard to see. In several instances, 4 images are placed on a single page, for which most of the page is blank background and the images tiny. This is a significant editorial failure, in my opinion. In addition, despite the purported advantages of high-field imaging, no attempt is made to demonstrate those advantages with regard to the cases presented. Rather, they are simply a collection of cases without any accompanying teaching. The small size of the images has negated any advantage of greater signal to noise.

The chapter on anatomy and pathology of the eye describes the chambers and spaces of the eye, by using cases of effusions and detachments, and also has many good examples of bread-and-butter ocular pathology. Many, but by no means all, of the images are of good quality.

The remaining chapters, which are fairly well organized, and in part due to the smart use of ophthalmology coauthors, contain much valuable clinical information of the type prized by radiologists. In particular, the chapters on lacrimal drainage, nerve sheath tumors, and pediatric neuroophthalmology imaging have very good material. Nevertheless, the recurring theme is that of very small or poorly reproduced images that unfortunately detract from their teaching value.

Although there is clearly much to learn from this book, it does not strike me as a likely substitute for a comprehensive textbook. Furthermore, most will acquire this book as part of a subscription to the Neuroimaging Clinics series; few will be pursuing it as they would a textbook. Rather it should serve as a complement to the collection of those who subscribe to the Clinics, and perhaps to fellows in training or a meeting attendee looking for a small book on the subject of orbital and ocular imaging.