The accidental discovery of roentgenography at the beginning of the 20th century revolutionized musculoskeletal imaging, as for the first time bony structures could be visualized non-invasively. At the beginning of the 21st century, equally revolutionary advances in imaging in rheumatology have transformed clinical practice and our understanding of rheumatological disease. Previous dependency on plain radiography has been superseded by the application of modalities such as scintigraphy, ultrasonography and magnetic resonance imaging (MRI). These techniques now allow detailed imaging of the structure and function of the soft tissues and bones and are now routinely applied in the diagnosis and treatment of rheumatic diseases, as well as in the investigation of their pathogenesis. Previous rheumatology and radiology textbooks have, by definition, tended to serve the interests of one group or the other, rheumatological textbooks providing fewer imaging figures and radiology textbooks providing less clinical context. Now a rheumatologist and a radiologist have edited a new textbook designed to serve as a resource for both radiologists and rheumatologists from trainee to senior physician. In order to ensure a balanced text, they have recruited 58 contributors from the ranks of rheumatologists and radiologists.
Imaging in Rheumatology is divided into three principal sections designed to improve access both for those requiring more technical information on imaging modalities and for those who may seek to understand the application of imaging in specific rheumatological settings. The first section is particularly aimed at non-radiologists and deals with modes of imaging. This provides a sufficient amount of technical information combined with a clear understanding of how the techniques may be applied in practice. The second section deals with how to image common rheumatological problems, such as regional limb or spine pain, and deals systematically with the application of the different modalities in diagnosis. This section is targeted at both rheumatologists and radiologists but is also of practical use for any musculoskeletal physician. A useful feature in some of these chapters is the provision of guidelines about which modality is optimal for each problem. Finally, the imaging of diseases ranging from rheumatoid arthritis and systemic vasculitis to soft tissue rheumatism and inherited disorders is covered. This is the largest section, occupying over half of the text, and each chapter seeks to combine brief but informative clinical information with a wide range of images. This approach occasionally leads to repetition between the three sections but makes the text extremely accessible to the busy clinician or radiologist.
The text is extremely well referenced and up to date, which is difficult in such a rapidly evolving field. There are sufficient high-quality images but it would have been preferable for the colour images to be placed in their relevant sections rather than in a separate section. An extensive range of pathology is covered in the comprehensive chapters, though, as mentioned already, this can lead to repetition. The authors correctly highlight the importance of MRI and ultrasound in delineating soft tissue pathology and anatomy. However, musculoskeletal ultrasound is given less prominence, with quite a small introductory chapter. This does not reflect the increasing interest among rheumatologists, as manifested by the full subscriptions at the BSR and EULAR musculoskeletal ultrasound courses. It is likely that more and more rheumatologists will practise ultrasound in the next few years and future editions may need to extend the ultrasound sections.
As a rheumatologist, I tested the book in my clinical practice for 8 weeks and found the balance of clinical rheumatology and technical radiology just right. This allowed me to access the information I needed rapidly as clinical problems arose, but I could also find greater detail when preparing teaching or research presentations. I think it will be a valuable textbook for radiologists too, providing succinct clinical information in order to assist in the interpretation of musculoskeletal imaging. By meeting the needs of both radiologists and rheumatologists, this text is accessible to trainees in either speciality but has sufficient complexity for their trainers too.
The author has declared no conflicts of interest.