Diagnostic Imaging: Interventional Procedures

Walker TG, lead ed. Diagnostic Imaging: Interventional Procedures. Amirsys; 2012; 800 pgs.; $339.00.

The newest in a long line of remarkably successful Diagnostic Imaging textbooks by Amirsys is the recent (2013) publication Interventional Procedures. This book has 21 authors, 19 of whom are part of the Interventional Radiology staff at Massachusetts General Hospital.

This hardcover book, approximately 750 pages in length, follows a format familiar to virtually any practicing radiologist—bullet points, pertinent images, exquisite drawings, and complete coverage of the chapter’s topic. There are 7 sections in this book. The first is General Considerations, with two chapters—one on Preprocedural Imaging and the other on Procedural Patient Management, the latter being particularly important since, among other issues, it summarizes the critical issues in contrast reactions and their treatment, the various conscious sedation options, and issues involving obtaining consent. This is important information for all radiologists whether or not they are directly involved in interventional procedures. The remaining sections are: Interventional Neuroradiology Procedure; Arterial Procedures; Venous, Portal and Lymphatic Procedures; Nonvascular Procedures; Oncologic Procedures; Post-transplant Procedures.

What will hold most interest for the readers of the AJNR, whether they are involved in interventional procedures or not, is the 85-page section on Neurointervention and the 11-page section on nerve blocks and facet blocks. The Neurointervention Section is divided into procedures related to primary vascular abnormalities (termed “neurovascular revascularization procedures”), to neurovascular diseases (termed “neurovascular exclusion procedures”), and to non-vascular spine interventions (vertebral augmentation: vertebroplasties and kyphoplasties). While the remarks in this review pertain to procedure in neurointervention, it is to be emphasized that since the field of interventional radiology is rapidly expanding, there is a benefit all to radiologists to be familiar with the procedures performed in every area of the body and the typical imaging findings pre/post procedures, along with their complications and outcomes, regardless of whether they themselves perform these procedures. As radiology becomes increasingly subspecialized, it is not surprising that many diagnostic radiologists (even neuroradiologists) are unaware of or have forgotten about the many interventional procedures now being performed.

Concerning neurointerventions, a few examples will suffice to explain the value of the book. In the chapter entitled “stroke therapy,” the authors start  with the terminology used and go from there to indications for therapy, both IV (one could quibble about their use of a 3-hour window for IV thrombolysis) and intra-arterial, contradictions, preprocedural imaging, including metrics used with CT/MR, and, of course, this being an interventional book, a description of the step-by-step procedure in intra-arterial therapy (thrombolysis, mechanical embolectomy/thrombectomy, angioplasty) and suggestions on the reporting of the procedure. Outcomes, both expected and potential complications, are described with specific recommendations for treatment and patient monitoring. As in all chapters, this written material is supplemented with high-quality imaging examples of thrombotic MCA stroke with treatment (including a diagram of the use of the Merc Retrieval System), basilar artery stroke/interventional, and an unsuccessful treatment of a basilar artery stroke. As in all chapters the key material, which the authors wish to emphasize, is summarized in a chart entitled “Key Facts.”

Within the areas of interest to diagnostic neuroradiologists and neurointerventionalists are chapters on carotid/vertebral artery angioplasty and stenting, intracranial vascular stenosis, stenting and angioplasty; stroke therapy (see above); and individual chapters on the treatment of the following: vasospasm, cerebral venous thrombosis, intracranial aneurysms, AVMs, dural arteriovenous fistulas, spinal DAVFs and AVMs, tumors, and epistaxis. For the spine, there chapters on vertebral augmentation (the authors don’t delve into the controversies surrounding kyphoplasty, which is proper, since this is a “how-to” chapter).

In the area of pain management, one chapter deals with nerve blocks, and the other deals with facet blocks. Although the call for it is infrequent, another chapter on the treatment of CSF leaks, particularly those in the spine from, for example, a ruptured perineural cyst with an epidural blood patch treatment, would have added value to this section, since the symptoms related to spontaneous intracranial hypotension represent a pain management issue. Taking the Facet blocks chapter as an example of the material on pain management, the reader is given information on the preprocedural analysis of the imaging, what coagulation factors need to be checked, medications to be used, various approaches to different segments of the spine, a step-by step procedure, outcomes, and potential complications. In none of this are we shown examples where entrance into a facet joint was particularly difficult, which, as we all know, can often stymie a facet injection or result in the inability to rupture a synovial cyst. Nonetheless, this is a chapter to be studied carefully, particularly for those who are newly involved in spine interventions.

The book should be on the shelf of every practicing interventionalist, and certainly, the book should be available to (in fact, should be required reading) for all residents and fellows as they become involved in the many IR procedures. There are so many key points raised in each chapter that copies of critical segments of each procedure should be readily available in IR suites. Diagnostic Imaging: Interventional Procedures comes with the highest possible recommendation.

Diagnostic Imaging Interventinal Procedures-Walker

Disclosure: Though AJNR book reviews are anonymous, it is hereby disclosed that the author of this review is related to one of the 21 co-authors of this book. The reviewer does not believe this relationship poses a significant conflict of interest due to the large number of contributing authors.

Diagnostic Imaging: Interventional Procedures