Color Doppler flow imaging: W. Dennis Foley, Boston, 1991, Andover Medical, 175 pages, $125

Abstract

Color Doppler flow imaging W. Dennis Foley, Boston, 1991, Andover Medical, 175 pages, $125. This book presents a radiologist's view of vascular diagnosis in a beautifully illustrated format. Color Doppler flow imaging (CDFI) is the most recent development in the rapidly changing field of duplex scanning. The ability to visualize flow patterns has attracted image-based diagnosticians to the vascular laboratory and has led to attempts to classify disease on the basis of the color image, often without adequate attention to the now well-established methods of velocity waveform analysis. Dr. Foley is an accomplished radiologist with extensive experience in CDFI. He and his coauthors have a good working knowledge of both imaging techniques and velocity analysis, but they rely primarily on the image for diagnosis. Their text lacks detailed discussion of normal and abnormal waveform patterns. The opening chapter on basic principles is very thorough and informative and provides a good background on the importance of Doppler angle, aliasing, frame rate, and proper setup of the instrument for color imaging. The remainder of the book deals with specific regions, including the head and neck, abdomen, transplants, extremity arterial and venous disease, and the genitourinary system. There is little discussion of mesenteric, common iliac, and renal artery stenosis because the authors' CDFI instrument was not able to study these deep structures. In general, the presentation of CDFI techniques is excellent and well illustrated. The authors try to define the role of CDFI in the evaluation of vascular patients; however, they treat this as a separate modality rather than as an extension of duplex scanning. Their approach to vascular diagnosis uses imaging to measure diameter reductions and gives relatively little attention to velocity waveform analysis. This would not be acceptable in most noninvasive laboratories directed by vascular surgeons. The lack of attention to waveform analysis is particularly prominent in the chapter on diagnosis of deep venous thrombosis, in which the authors base their diagnosis on image analysis only. There are no examples of venous velocity waveforms, even though these can easily be obtained during CDFI. This approach may lead to errors in diagnosis that could be prevented by including the standard waveform analysis for respiratory variation, spontaneity, and symmetric augmentation. This book is well written, beautifully assembled, and richly illustrated with more than 140 color figures. One of the first of its kind, it is devoted entirely to color Doppler imaging. Some topics, such as sections on the neonatal brain and the orbit, will be of little interest to vascular surgeons. However, the book is well worth reading for anyone who is beginning to use color Doppler imaging. It does not give an adequate presentation of conventional velocity waveform analysis and therefore should not be used as a sole text for those who do not have a firm background in this area. New editions of current textbooks on noninvasive vascular diagnosis will soon be appearing with extensive sections on the use of color Doppler imaging. These texts, which are firmly based on conventional waveform analysis, will provide a more balanced presentation, adding color imaging to duplex scanning rather than treating it as a separate modality.