Book review

Abstract

Adrenal Imaging Michael A. Blake, Giles W.L. Boland Totowa, NJ: Humana Press; 2009. $199.00; 218 pages; Illustrated; Hardcover Bobby Kalb MD*, * Emory University School of Medicine, Atlanta, Georgia, USA. The authors' stated purpose of the text is to distill the current state of knowledge available concerning imaging of the adrenal gland into a single volume, and to include information on the adrenal gland from other medical disciplines besides imaging. The text represents a comprehensive overview of the adrenal gland, including embryology, pathology, various imaging techniques, biopsy, and surgical intervention. The illustrations in this book are excellent, and include gross and microscopic photographs (all in color), multiple diagrams and diagnostic flow charts, and also multiple imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine. The 218 pages of text are divided into 13 chapters. The first five chapters deal primarily with nonimaging disciplines related to the adrenal gland. The first chapter begins with a discussion of adrenal embryology in addition to normal gross and microscopic anatomy. The remainder of the chapter is a well-written discussion of both diffuse and focal diseases affecting the adrenal gland from the perspective of the pathologist. The second and third chapters are focused on adrenal dysfunction, with an in-depth analysis of the hormonal effects of both the normal and diseased adrenal gland. These are two important chapters, as imaging must be correlated with biochemical analysis, and an understanding of the role of hormonal evaluation is helpful in imaging evaluation of the adrenal gland. The fourth chapter is shorter and focuses on the oncologic evaluation and therapeutic options for adrenal cortical carcinomas and paragangliomas, although discussion of additional adrenal neoplasms (such as lymphoma) is not provided and may have been beneficial. The fifth chapter begins with an interesting review of the history of adrenal anatomy and surgery. While there is some repetitive information regarding adrenal histology and hormonal evaluation, the diagrams and discussion of adrenalectomy (open and laparoscopic) are well done. Imaging of the adrenal gland is covered in the remaining chapters of the book. Chapter 6 describes the role of imaging in adrenal dysfunction, nicely discussing imaging findings in the context of clinical and laboratory findings. Chapter 7 is a comprehensive review dealing with the imaging of pheochromocytomas, with many illustrations showing a variety of presentations with multiple imaging modalities. The remaining chapters organize adrenal imaging based on imaging modality. Chapter 8 is a detailed analysis of CT evaluation of adrenal nodules, focusing primarily on noncontrast Hounsfield unit measurements and postcontrast washout calculations. There is also a useful flow chart detailing the authors' algorithm for work up of an adrenal lesion with CT. The authors do not, however, discuss more recently published data showing use of shorter washout exams with timing in the range of 5 min. Chapter 9 discusses the use of MRI in the evaluation of the adrenal gland with a variety of case illustrations. While this chapter covers the basics of adrenal MRI, including in-phase and opposed-phase imaging, there is not much emphasis on methodological detail and the authors have not provided a state-of-the art review of current MRI technology. For example, the authors discuss limitations of MRI resolution for visualization of the adrenal glands but do not discuss newer three-dimensional gradient echo imaging sequences that overcome much of the spatial resolution concerns relative to CT. In addition, more detail on sequence parameters necessary for adrenal imaging would be helpful for readers who are looking to adjust their MR protocols. Nuclear medicine imaging of the adrenal gland is the focus of the next two chapters. Chapter 10 evaluates the use of iodine-labeled metaiodobenzylguanidine (MIBG) and somatostatin receptor imaging, with excellent detail in the text on image acquisition. Chapter 11 discusses the use and limitations of positron emission tomography-CT (PET-CT) in adrenal imaging, with a discussion of newer PET tracers developed for the adrenal gland. Adrenal interventions and trauma are described in Chapter 12, with discussion of patient preparation, techniques, and complications. Interventions that are detailed include percutaneous biopsy, radiofrequency ablation, and adrenal vein sampling. The final chapter provides a good overview of evolving imaging techniques that are not in widespread clinical use for adrenal imaging, but many of which are under continued investigation. In summary, Adrenal Imaging is a well-written textbook that provides an easy to read overview of adrenal imaging with excellent pathologic and imaging illustrations. Limitations include a relative de-emphasis of MRI compared with the level of discussion provided for other modalities and some repetition of information between chapters. This textbook can be recommended as a useful first reference for radiologists and other physicians interested in a general reference on imaging of the adrenal gland.