The Whole Brain AtlasBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7223.1507 (Published 04 December 1999) Cite this as: BMJ 1999;319:1507
Keith A Johnson, J Alex Becker
Lippincott, Williams, and Wilkins, $150
ISBN 0 7817 1841 4
This technically ingenious CD Rom claims to offer a complete teaching guide to the imaging of brain anatomy based on magnetic resonance, computed tomography, positron emission tomography (or SPECT), plus a comprehensive guide to the imaging of brain pathology. Although the number of images cited seems enormous (13 000), it is achieved not by covering a correspondingly huge number of cases but by storing a vast number of images for each case or patient studied. Thus, for each case, the CD has the complete magnetic resonance studies (often in several modes), isotope studies, and in some cases computed tomographic studies, and so may provide hundreds of images.
These are organised on a simple “walk through” basis and navigated from a baseline image and coded control diagram. There are also several video clips, mainly of normal magnetic resonance angiograms of the neck and cerebral vessels, which reproduce the rotation of the vessels as seen on magnetic resonance visual displays. Again, a large number of still frames can be viewed separately.
The large number of isotope studies is difficult to justify since they add little to normal anatomical knowledge and, though useful in research and in certain conditions such as Alzheimer's disease and other dementias, they have little clinical value in most pathological brain studies. While this extravagant approach may be defensible for teaching or self teaching of anatomy, it seems rather wasteful and time consuming in teaching neuropathology. In practice, it is one of the reasons for the pathology section being unbalanced and based on only 30 cases. Thus, such vital subjects as congenital brain lesions and epilepsy are conspicuous by their absence, and others, such as neoplasm and trauma, are badly underrepresented.
In some cases the user is provided with well explained “guided tours” through an abnormality. In others, however, users may have to wade through a plethora of normal images to find those showing abnormality. These are usually unlabelled and without legends or descriptive reports, although a short clinical history can be easily produced by clicking on the appropriate code word.
Vascular lesions receive most attention (10 cases). Nearly all are labelled “acute” or “subacute” stroke and show infarcts. The important subject of subarachnoid haemorrhage is absent, while neoplasia is represented by only five cases and infections by only four. It is mystifying that one of these cases should be of a patient with Lyme disease, an interesting but rare condition, and why this case should be linked to a major article on the condition, a privilege not granted to more common diseases.
This compilation presents a good overview of normal brain anatomy, as displayed by modem imaging techniques, and introduces the user to the versatility of computer manipulation of images. The pathology section is more limited and, for the reasons mentioned above, can be regarded as only an introduction to a vast field that is better covered in standard textbooks.