156 CLINICAL RADIOLOGY

on ultrasound lists and the imposition of time consuming emergency venous Doppler examinations creates further imbalance of workload.

As a radiologist with considerable experience of both techniques and no axe to grind, I choose venography as my first line imaging technique. CDUS is a valuable adjunct when there is a contraindication such contrast allergy, pregnancy or the very occasional failure of venupuncture.

R. J. DAVIES Ashford Hospital Ashford, Middlesex, UK

Reference

1 Burn PR, Blunt DM, Sansom HE, Phelan MS. The radiologicai invest- igation of suspected lower limb deep venous thrombosis. Clinical Radiology 1997;52:625-628.

SIR - - I read with interest the results of the survey carried out by Dr Burn et al. [1] of current practice in imaging suspected lower limb deep venous thrombosis (DVT). This paper usefully highlights the continuing confusion and divergence of practice related to this common condition. The authors rightly conclude that if resources (such as the luxury of repeatedly scanning patients) and expertise are available, colour Doppler ultrasound (CDUS) may be the modality of choice for the investigation of the symptomatic lower limb.

I feel however that some of the authors comments may serve to reinforce the notion that patients with suspected lower limb DVT are a homogeneous group requiting in all but a few instances a blanket approach. In practice this is not the case particularly when investigating the potential source of suspected pulmonary embolism (PE) in high risk groups. In many centres

this accounts for a significant proportion of referrals. Most of these patients have asymptomatic lower limbs. A recent study by Lensing and colleagues comparing CDUS and compression US with venography in asymptomatic post op patients, showed ultrasound to have a sensitivity of 33% for calf vein thrombus and only 60% for proximal thrombus [2]. This is not an isolated result. A review article by Burke et al. lists several studies where the sensitivity of US is significantly inferior to venography in asymptomatic high risk patients [3].

As the authors rightly point out there is controversy over the management of isolated below knee DVT, however, one cannot use that as an excuse for being unable to image it. There is no controversy over the fact that finding below knee DVT is important in the furtherance of the diagnosis of PE. After all, it is usually the silent DVT which produces the fatal embolism.

The authors make the comment that 'the most common reason for preferring venography to CDUS was its alleged superior calf vein visualization'. There is nothing alleged about it.

J. I-I. REID Borders General Hospital, Melrose,

Roxburghshire, UK

References

1 Burn PR, Blunt DM, Sanson HE, Phelan S. The radiological investiga- tions of suspected lower limb deep vein thrombosis. Clinical Radiology 1997;52:625-628.

2 Lensing AW, Doris CI, McGrath FP et al. A comparison of compression ultrasound with color Doppler ultrasound for the diagnosis of symptom- less postoperative deep vein thrombosis. Archives of Internal Medicine 1997;157:765-768.

3 Burke B, Sostman HD, Carroll BA, Witty LA. The diagnostic approach to deep venous thrombosis. Clinics in Chest Medicine 1995; 16:253-268.

Book Reviews

Exercise in Diagnosis Imaging. By Sarah Burnett and Asif Saifuddin. Harwood Academic Publishers, The Netherlands, 1997. 139 pp.

This book will cater for specialist registrars who are about to sit the Part 2b Fellowship of the Royal College of Radiologists Examination. The book is aimed at preparation for the film viewing session of the examination. Eight cases are used for each practice examination and the cases are well chosen to cover plain films, barium work, CT, MR, ultrasound and nuclear medicine. The images are of good quality but some cases are rather too obvious and would probably not be included in the FRCR examination.

The authors have a well set out introduction. Each examination should be completed within i h. Model answers have been provided, as well as a list at the back of the book of the actual diagnosis for each case. As in the examination, the style of answering is left to the reader's personal choice.

The authors summarize the guidelines to candidates from the Royal College of Radiologists stating that credit will be given for clarity of presentation, correct observations, correct deductions and diagnosis, a sensible brief discussion of differential diagnosis if appropriate, and further investigations and management of patients where appropriate.

This book functions adequately as a quick examination practice, but has limited long-term value.

P. Gishen

Diagnostic Breast Imaging. By Heywang-Kobrunnel, Scheer and Der- shaw. Thieme, New York, 1997. 403 pp. 178.00 DM

This is the best all round book on breast imaging I have seen. The three authors, all internationally recognized experts in this field, have produced a concise yet very well illustrated and referenced text. This is the first book to successfully try to bridge the 'Atlantic divide' and addresses very well the variety- of clinical issues on the appropriate use of breast imaging in both the United States and Europe.

The book is divided into three parts - methods, appearances and applications. The first provides detailed description of the various imaging techniques including mammography, ultrasound and MR imaging, and their appropriate clinical applications. This section also includes balance descriptions of the various 'interventional' breast imaging techniques such as image-guided biopsy and localization, and galactography. The second section describes the various imaging appearances of virtually every breast problem a radiologist is ever likely to encounter; there is excellent correlation between bridging findings of the various techniques and image

quality is excellent. In the final section, the authors deal with the appro- priate use of the various imaging techniques and the diagnostic process and provide a variety of diagnostic algorithms.

There is plenty here for both the novice and expert breast radiologist. This is an excellent book and I only wish I had written it myself - I commend it to all radiologists involved in breast imaging.

R. Wilson

Pulmonary and Cardiac Imaging. By C. Chiles and C. Putman. Marcel Dekker Inc., USA, 1997. 601 pp.

This is textbook is a multi-author American volume with contributions by almost 40 authors, most of whom are radiologists and many of whom are well known authorities in their field.

Over two-thirds of the volume is devoted to pulmonary imaging with a variety of topical chapters including imaging in both the immnno-compro- mised patient and the AIDS patient in particular. Sections on imaging of bronchial carcinoma and metastatic disease in the chest are thorough with important differential diagnostic pathways well outlined. The topics of chest trauma and thoracic surgical complications are covered in detail and are comprehensive. Intra-pulmonary disease processes are well reviewed and all major intra-pulmonary pathologies are covered in a variety of chapters.

The section on thoracic interventional procedures is particularly prac- tical, giving precise accounts of procedures including transthoracic needle biopsy, thoracic drainage procedures and parenchymal drainage proce- dures. A chapter on imaging of the pulmonary circulation is presented in an interesting way with the different imaging modaiities being used as a framework for assessing the vascularity in different conditions, most particularly pulmonary embolism. There is a useful technical chapter on digital imaging of the chest.

The cardiac section of the section is contained within 175 pages but in spite in the conciseness of this section it is remarkable how thorough the book has been. Some topics are covered in a rather limited way, e.g. the intravascular coronary ultrasound section is very short but still outlines the main aspects of the technique. Pericardial imaging is covered thoroughly and there is a useful section on adult congenital heart disease which is becoming of increasingly topicaI interest.

Intraventional techniques in cardiac diagnosis are also covered with angioscopy, angioplasty, laser, atheromatectomy mad of course stenting all

�9 1998 The Royal College of Radiologists, Clinical Radiology, 53, 155-157.

BOOK REVIEWS 157

being reviewed. The final chapter outlines a series of advances in cardiac imaging, pointing the way towards the future.

The overall impression is of a remarkably comprehensive book, perhaps a little short on detail in some areas but immensely valuable as a reference, particularly in the section of pulmonary imaging. I suspect that it is less strong in the field of cardiac imaging. In all cases the quality of imaging is good and the different modalities are well demonstrated.

I think this book would make an excellent contribution to a radiological

library particularly where there are trainees present and particularly where there is a significant amount of specialist pulmonary radiology. I think it leads into the subject of cardiac imaging in an interesting way but should not be used as a definitive text in this field.

P. Wilde

Individuals wishing to order books should contact the publisher of the book direct.

�9 1998 The Royal College of Radiologists, Clinical Radiology, 53, 155-157.