Magnetic Resonance of Myelination and Myelin Disorders, 3rd ed

Marjo S. van der Knaap and Jaap Valk, eds. New York: Springer; 2005, 1084 pages, 3873 illustrations, $499.

In recent years there has been immense progress in the knowledge of genetic defects, biochemical abnormalities, and cellular processes underlying myelin disorders. This progress prompted the editors of Magnetic Resonance of Myelination to create the third edition of this book. The editors have tried to cover most white matter disorders and to present a collection of images illustrating the field in an extensive fashion. The editors, one a neurologist and the other a neuroradiologist, have invited 13 contributors in specialized fields to write or co-write selected chapters.

The book is divided into 109 chapters. The first 4 chapters are introductory and deal with the anatomy and function of myelin disorders, selective vulnerability, and normal as well as retarded myelination. Chapter 1 has exquisite diagrams detailing the anatomy of myelin. Chapter 2 describes several classification schemes, which are a bit superfluous for most readers. The classification of leukoencephalopathies proposed by the authors would suffice as the most functional one. It divides leukoencephalopathies into hereditary disorders and acquired disorders. The hereditary demyelinating disorders are then classified according to the subcellular localization of the underlying metabolic defect, which stresses the clinical, biochemical, and neuropathologic similarities and differences between categories. The acquired demyelinating disorders are classified according to their underlying causes into noninfectious–inflammatory, infectious–inflammatory, toxic–metabolic, hypoxic–ischemic, and traumatic. The chapter on selective vulnerability (chapter 3) provides nice examples of areas predominantly involved in particular disorders. The recognition of patterns of selective vulnerability is of practical value and contributes to the diagnostic specificity of MRI interpretation. The concept of MRI pattern recognition is based on the concept of selective vulnerability. Specific brain regions may be more vulnerable to particular injuries than others. Chapter 4 deals with normal as well as retarded myelination. The chapter describes myelination and gyration patterns. It also discusses the use of diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) to determine maturation. The images are generally good, although some of them could be larger because there are quite large blank spaces in many of the pages.

Chapters 5 through 105 describe particular leukoencephalopathies following the authors’ classification scheme. The format followed in these chapters is as follows: clinical features, pathology, therapy, and MRI. In total, there are 647 figures in this book, providing excellent examples of many leukoencephalopathies. T1-weighted and T2-weighted images, as well as FLAIR images in multiple planes, are shown. Tables are provided in many of the chapters. For example, in the chapter on multiple sclerosis (MS), a table is included on the criteria for diagnosis of MS. Another table is provided that depicts MR sequences that may be included in a protocol, including an indication of the MS features in which they are effective.

The next 3 chapters deal with imaging techniques such as diffusion-weighted imaging, magnetization transfer (MT) imaging, and MR spectroscopy (MRS). The chapters not only explain the techniques in very understandable language, but they also show multiple examples of technical applications in particular leukoencephalopathies. For example, DWI and DTI have been applied extensively in MS. Fractional anisotropy and apparent diffusion coefficient values are used to compare different tissue components of MS such as plaques, white matter, and enhancing versus nonenhancing lesions. The authors demonstrate that background reduction as produced by MT pulses can be applied to improve the effect of contrast enhancement in the search for the number of enhancing MS lesions, including a second application of MT, which gives a quantitative impression of the structural integrity of the brain tissue. Also described are the 2 types of spectroscopic abnormalities seen in white matter disorders: process-specific spectroscopic abnormalities related to delayed maturation and tissue damage, and disease-specific spectroscopic changes directly related to the particular disorder under investigation.

Finally, the last chapter deals with pattern recognition in white matter disorders. This chapter provides 13 examples of leukoencephalopathies, including those linked to chromosomal abnormalities. This is a very good chapter for review and for practical tips.

The reference section made up of 168 pages is the most extensive I have seen in any textbook. References are grouped into their respective chapter. Any reader wanting further reading on any of the leukoencephalopathies has plenty of sources to investigate. Overall, this book is well written and covers an important area of neuroradiology in a very extensive fashion. The book is extremely well referenced and well illustrated. It is highly recommended.