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Imaging of Small Intestinal Tumours

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Imaging of Small Intestinal Tumours. Edited by Gourtosyiannis NC, Nolan DJ. (Pp 414; illustrated; $284.50.) Elsevier Science, 1997. ISBN 0-444-89997-9.

I was interested to learn that the radiology of small bowel tumours was first described by Golden in 1928. Since then all the standard works on gastrointestinal radiology have contained sections on small bowel tumours, but to my knowledge no other single work on this subject matter has emerged. Small bowel tumours represent less than 2% of all primary gastrointestinal (GI) tract tumours, but change in endoscopic practice means that the small bowel is now of greater importance to the GI radiologist, making a book devoted to the radiological diagnosis of small bowel tumours more relevant.

The editors are well known proponents of the enteroclysis technique, so that it is not surprising that the majority of illustrations relate to this diagnostic modality. Few would disagree with this, as the consensus view is that enteroclysis is the examination of choice for the diagnosis of small bowel tumours. Other techniques are well represented, with an international selection of authors covering sections on angiography, ultrasonography, and computed tomography (CT).

It was pleasing to see colour illustrations in the section on pathology. The authors, from the Armed Forces Institute of Pathology in Washington, have provided an authoritative but succinct account that is easy to follow, and contains the right amount of detail for radiologists. The remainder of the book is divided into benign neoplasms, primary and secondary malignant neoplasms, polyposis syndromes, neoplasms of the duodenum, non-neoplastic tumours, and other imaging techniques. There are some nice colour illustrations of pathology specimens. The enteroclysis images predominate and are mostly of good quality. There is a scattering of other modalities illustrated, mainly CT, within the tumour specific chapters. This balance is appropriate in centres where high quality, dedicated, small bowel examinations are performed, though I suspect that CT may be used as frequently as enteroclysis for primary diagnosis in many parts of the world.

Small bowel involvement in the polyposis syndromes is of interest, not only for symptomatic diagnosis, but also for the role that radiology has in monitoring for potential complications. This is particularly true in Peutz-Jeghers syndrome, where periodic small bowel examination may be indicated to detect any polyp development. Any polyp larger than 2 cm should be considered for resection to avoid intussusception. The authors rightly emphasise the problem of periampullary carcinoma in familial adenomatous polyposis (FAP), though I would question their statement that this is related to colectomy. However, this is true of desmoid formation, which is an important topic rather lost within a section on the extracolonic manifestations of FAP or Gardner’s syndrome. The magnetic resonance imaging, CT and small bowel features of desmoid disease are not described, though it is a significant management problem and cause of mortality.

This is a well produced book, containing a wealth of information on what might be considered a slightly obtuse subject. Most of the standard reference works on gastrointestinal radiology will provide enough detail on small bowel tumours for the average reader. However, uncommon lesions tend to cause diagnostic difficulties, and this work should find its way into department libraries to deal with those occasions.