McKinney, AM. Atlas of Normal Imaging Variations of the Brain, Skull, and Craniocervical Vasculature. Springer; 2018; 1335 pp; 294 ill; $349.00

Cover of McKinney
This two-volume text, Atlas of Normal Imaging Variations of the Brain, Skull, and Craniocervical Vasculature, is destined to become a classic in neuroradiology.  Dr. Alexander McKinney has put together in 1330 pages a vast compendium of normal structures/variations encountered in neuroimaging. One is immediately struck by the excellent images throughout both volumes, the completeness of the material included, and the succinct descriptions in both the legends and the text material that precede each particular entity under consideration. There are what could be considered 45 “chapters,” but they are more selected topics in variations. The reality of everyday practice is that there are certain observations that make us wonder if a “finding” is pathologic or a usual/unusual variation. These often cause the greatest consternation.  If it is thought to be a normal variant, what exactly is it? Here, then, is the value of this set of books.

This review will not list each of the topics/chapters covered; that list can be accessed online. Rather, we will look at 3 topics, 1 each from the brain, the skull, and the craniocervical vasculature in order to highlight the value of these books.

In the 21-page description of the pineal gland, we have 130 images dealing with size, enhancement, appearance, cysts, and calcifications. The details help clarify when we are at the borderlands of normal or move to a frankly abnormal situation. In this chapter, there are abundant images, as is true in all of the other chapters, thus sticking to the concept of this being a true atlas. Companion cases of abnormalities in these areas solidify in one’s mind the difference between borderlines of normal variation and pathology.

Base of skull emissary veins, vessels in foramina, and skull depression can be sources of confusion in a number of circumstances, particularly in trauma situations. In a 25-page chapter, vascular channels, symmetric or asymmetric foramina, sutural lines, and prominent vessels are shown in 116 images. This, in conjunction with the “Do Not Touch” chapter–which describes mimickers of pathology, such as arachnoid granulations, calvarial depressions, hemangiomas, and intraosseus lipomas–will help one avoid overcalling findings that may be striking but are nonetheless normal. Going through all of the images in both of these chapters will also assist one in avoiding requests for further or follow-up imaging. This reviewer found a number of these illustrations (which are also in many other chapters) very educational, as they warn of how to avoid mistakes.

Variations in normal craniocervical vasculature are common, so recognition of these arterial and venous alterations is important, not only to correctly identify them but also to separate them from possible pathologic conditions. In this section of the book (15 chapters and 373 pages in length), nearly every conceivable anomaly/variation from the aortic arch through the brain is shown. Venous variations are also included. Importantly, there is ample space devoted to the technical aspects of noninvasive CT/MR angiographic imaging, which, because of artifacts, overlying structures, and segmented images, can cause misinterpretations.

Dr. McKinney has done neuroradiology a great favor by putting together this monumental work. At any conference where Springer is displaying textbooks, make sure that you look closely at this two-volume set. It would be a wise purchase for personal use or for a departmental library. It receives the highest recommendation for a purchase.


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