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lesions in flat bones, including the spine-an observation not made. The fact that Hodgkin's disease, lymphosarcoma and reticulum cell sarcoma often produce similar radiological features is not stressed. No reference is made to the distinction between primary reticulum cell sarcoma of bone and reticulum cell sarcoma (lymphoma type). Two cases diagnosed as giant cell tumors of the spine are open to question-are they perhaps aneurysmal bone cysts? The statement "lung tumors usually cause lytic metastases, but sclerotic changes are not uncommon" must be challenged, since sclerotic changes are indeed uncommon. Fibrous dysplasia affecting the spine usually is accompanied by disk space narrowing-a feature of this disorder not mentioned in the text. The statement "bone reaction is minimal" in tuberculous spondylitis is disputed by the reviewer, inasmuch as almost 25% of cases affecting the thoracic and lumbar spine demonstrate sclerotic changes, often considerable in extent. "Despite the fact that sarcoidosis may involve cerebrospinal soft tissues, spinal bone changes are unknown" is an experience not shared by the reviewer. The statement "compression fractures (of Cushing's disease) ... present an appearance similar to ... osteoporosis and osteomalacia" needs qualification, since relatively abundant subarticular dense callus occurs frequently in instances (in approximately half the cases) of vertebral fractures associated with Cushing's disease, but not in osteoporosis or osteomalacia. In fairness to Dr. Epstein, the attitude inherent in the statement "water-soluble contrast material has no place in the identification of lesions above L-1" existed probably when this book went to press (newer advances have made this statement obsolete). In Fig. 204-an example of metastatic disease from carcinoma of the pancreas-an x is used to indicate a destroyed pedicle which, in fact, is intact, while the pedicle of the vertebra above is destroyed and, finally, Fig. 246 is presented as an example of hemangioblastoma of the cervical cord (without biopsy proof) because the lesion was highly vascular on angiography. Although radiotherapy produced marked amelioration of symptoms and signs, Dr. Epstein's scientific acumen is such that he must know that this diagnosis is in no way established. These observations should not be construed as a major criticism of the basic excellence of the work. The areas of disagreement represent relatively unimportant peccadillos in the context of a superior effort. In some instances the criticisms indicate only a difference of opinion between the author and reviewer in areas which permit no final determination between correct and incorrect. At the very least, a compilation of such criticisms, point by point, v~rifies that the text has been read carefully-an expected 'responsibility of and a distinct pleasure for the reviewer since (a) this he was expected to do and (b) by this careful perusal he learned a great deal. This book is a significant addition to the neuroradiological Iiterature-a work which was to be expected of Dr. Epstein in view of his many superb efforts of the past. The book is recommended highly for general radiologists, neuroradiologists, orthopedic clinicians and practitioners of the neurological sciences. Residents in radiology and medical students assigned to radiology will find this book instructive and useful. HAROLD G. JACOBSON, M.D.
Radiology – Radiological Society of North America, Inc.
Published: Sep 1, 1975
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