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An atlas of neonatal brain sonography.
  1. MALCOLM LEVENE, Professor of Paediatrics
  1. General Infirmary, Leeds

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    An atlas of neonatal brain sonography. P Govaert, L S de Vries eds. (Pp 363; £50 hardback) Cambridge University Press, 1997. ISBN 1-898683-09-3

    In the early 1970s intracranial haemorrhage in prematurely born babies was thought to be predominantly fatal, with the few survivors developing post haemorrhagic hydrocephalus. With the introduction of computed tomography brain scanning of surviving premature infants, it was found that far from being fatal, most infants who had intraventricular haemorrhage survived—and often with few or no abnormal neurological signs. In the late 1970s real-time ultrasonography was shown to be a convenient, safe, and reproducible technique for imaging the newborn baby’s brain and improvements in technology now mean that every neonatal unit in the developed world has access to high quality ultrasound imaging.

    There can be little doubt that this title represents the definitive work on neonatal cranial ultrasound. The authors have had extensive experience in the use of ultrasound scanning the neonatal brain for almost as long as ultrasound has been used to investigate intracranial pathology on the neonatal unit; their combined experience is most impressive. The book covers every aspect of ultrasound brain imaging currently available and discusses variations of every form of pathology evident by this technique.

    The illustrations are extremely good and considerable pains have been taken to ensure that they are reproduced to best effect. One problem, as the authors readily admit, is knowing the clinical significance of some of the appearances they describe. Do they represent pathology or are they normal or developmental variants?

    Unfortunately, the strength of this book is also its weakness. By showing examples of so much pathology, with many of the abnormalities being relatively subtle, begs the question of whether more information could be obtained from other imaging modalities. In recent years magnetic resonance has become a very important technique for imaging the brain, and to some extent, ultrasound and magnetic resonance are complementary. In other indications, particularly in mature infants, magnetic resonance is the best technique for recognising many forms of pathology. By concentrating on the minutiae of ultrasound imaging, the reader misses the point as to what is the best way of diagnosing abnormalities. The art of modern imaging is not to expect a great level of skill in one technique but the best selection of imaging tools from the range of techniques available. It is a great pity that this excellent book did not include more magnetic resonance or computed tomography images with comments on the advantages and disadvantages of each. The authors acknowledge this criticism in the second sentence of their preface, but do not explain why they did not extend the scope of the book.

    This book tells you everything you need to know about neonatal cranial imaging with superb illustrations, but it does not tell the clinician what s/he really needs to know, which is the limitation of ultrasound as a diagnostic technique and how other modalities can aid in more accurate diagnosis.