Torres CH, guest ed. Mukherji SK, consulting ed. Neuroimaging Clinics: Spinal Tumors. Theclinics.com; 2023;33(3):375–530; Online and print $413.00; Online only $359.00

In addition to a solid review of tumors of the spine, this issue of the Neuroimaging Clinics takes the reader to areas of spine imaging which are important not only for the daily interpretation of spine imaging but also for a deeper understanding of the issues involved in patient evaluation and clinical management.

Edited by Carlos Torres, MD from the University of Ottawa, Canada the August 2023 issue of the Neuroimaging Clinics contains chapters, written by 39 authors/co-authors.  The chapters are as follows:

Pediatric Spine Tumors and Dysontogenic Masses

Conventional and Advanced Imaging of Spinal Cord Tumors

Intradural Extramedullary Tumors and Associated Syndromes

Spinal Tumor Mimics

Imaging of Common and Infrequent Extradural Tumors

Diffusion Weighted Imaging in Spine Tumors

Dynamic Contrast Enhanced MR Perfusion in Vertebral Body Tumors

Management Algorithm for Osseous Metastatic Disease.

Percutaneous Treatment of Spinal Metastasis

3D Printing in Treatment Planning of Spine and Sacral Tumors

Just by looking at these chapter titles, one can clearly surmise that there is crucial information and critical clinical discussions that will impact the diagnoses and ongoing interactions between the radiologist and the clinical teams caring for these patients.   This edition of the Neuroimaging Clinics meets and in fact surpasses all expectations for a volume on this topic.  Before highlighting some of the areas covered in this book, it should be emphasized that Dr. Torres has done an outstanding job in selecting topics for this edition. And to Suresh Mukherji, MD for selecting this topic and for having Dr. Torres spearhead this initiative, kudos.

This is a highly illustrated volume rich with abundant figures a fact that allows the reader to readily appreciate the associated written material.   One could easily go through all the chapters and look at the figures and the associated legends. It should be mentioned however that although the majority of images are adequate in brightness and contrast some images fall short of proper window width and level (there are a considerable number of instances of this—- take as just three examples, figure 4 C in the chapter on DWI, figure 3 A in the chapter on Advanced Imaging, figure 5D in the chapter on Pediatric tumors).  In those cases, and in others, the features which the authors want to emphasize are seen (albeit sub optimally); nonetheless it is not clear why in the production/ printing of these volumes more attention is not paid to proper image settings of all figures.

Now to the substance of the material.  The first chapter includes both common pediatric spinal tumors such as myxopapillary ependymomas, neurenteric cysts, NF 1 and NF 2 but also includes descriptions and illustrations of lesions infrequently encountered such as bone lesions and epidural masses.  Apparently in an ill-advised attempt to save space, the formatting of the bone tumors results in such small images that it is a strain to appreciate the features (see Figure 9 in which there are 26 images squeezed into one-third of a page).  One should not have to use a magnifying glass to look at the images.

The chapter on advanced imaging demonstrates a number of potentially valuable techniques such as DTI tractography (showing tract displacement versus tract involvement/ encasement), PET CT, and dynamic contrast enhancement.   In addition, this chapter includes good examples of various spinal tumors and with them indicates the probable usefulness of newer techniques.  Of particular interest is the chapter on “Troublemaking Lesions:  Mimics of Spinal Tumors”.  This chapter deserves extra attention by the reader since there are pitfalls which can send the clinicians, surgeons, and radiologists to the wrong diagnosis.   Beautifully shown are a number of such examples:  cavernous malformations, dural fistulas, NMO, acute inflammatory MS, cord infarction, ADEM, neurosarcoidosis, cord abscess and other infections, epidermoids, neurenteric cysts, dermoid cysts, extramedullary hematopoiesis.  Of all the chapters in this volume, this one should be the most carefully studied to avoid missteps and pitfalls.  Highlighted and illustrated are inflammatory, vascular, infectious, congenital/developmental, and extradural/intradural lesions.  Most bothersome of all these entities are NMO spectrum, ADEM with fulminate changes in the cord, and the old bug-a-boo “transverse myelitis”.  The authors of this chapter do a fine job in describing these often-difficult diagnoses.   A good follow up chapter to the above is the description of common and far less common lesions involving the extradural space (bony and soft tissues).  As in all the other chapters, one derives important educational points by closely inspecting the images and the associated legends. Not to overemphasize the point made earlier in this review but features which the authors wish to point out are sometimes lost due to the poor reproduction of the images (take figure 2C in this chapter as an example.)

Performed properly and with good technique, the chapter on DWI of spinal tumors shows that in specific instances DWI can be helpful in differential diagnoses and to a certain extent in surgical planning, especially the fiber tractography.  The drawings (cartoons) which accompany the chapter assist in the understanding of the basic elements of DWI.  A short (9 pages) chapter on the description of MR perfusion allows one to see the potential of this less than commonly utilized technique.  The authors of this chapter indicate that pMR is in their practice implemented often, so it is beneficial to see how in their hands, perfusion studies add to the imaging information.

The last three chapters combine imaging with correlative clinical and treatment options/ considerations. For those involved in spine interventions, the chapter on percutaneous treatment of spinal metastasis will be of great interest since it includes information on thermal ablation —–RF ablation, cryoablation, microwave ablation—along with thermal protection, and vertebral augmentation.  To show where the world of surgical planning and operative intervention is heading, one should read the last chapter on the role of 3D printing in the treatment of spinal and sacral tumors.  While these items are not usually thought of by radiologists, it is worthwhile to know what spine surgeons either now use or will be using in these difficult operations.  As an aside (and it is a minor part of this chapter) this reviewer found the figure (figure 13) which shows the configurations, shapes, and appearances of various titanium interbody cages to be helpful.  Perhaps with these images and the specific names given to each one, we can more easily identify and name the cages we see on radiographs and cross-sectional imaging

To sum it up, this volume of the Neuroimaging Clinics is outstanding and should receive the attention of every radiologist who does substantial spine imaging.   It is a highly recommended volume.