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Gastrointestinal radiology. A pattern approach (4th edn). Edited by R L Eisenberg, pp. 1356, 2002 (Lippincott Williams & Wilkins, Baltimore, MD), $199.00 ISBN 0-7817-3706-0

This single volume book comprising 1356 pages was published in 2003 and represents a 7-year update with several changes to the 3rd edition, including an expansion of the CT and MR section pertaining to the liver. Unlike other major texts on alimentary tract radiology, this book focuses on a pattern approach to diagnosis. Indeed, the reliance on a pattern-approach is the raison d'etre for this publication.

The book is written using American spelling and expressions although this is rarely problematic. Where problems do arise, they are largely around classifications or pathological terminology. For example, villoglandular polyp would be more readily understood by the UK reader as "tubovillous". Most spindle cell tumours of the GI tract are more commonly termed gastrointestinal stromal tumours (GIST).

Although this edition has been strengthened by the addition of chapters on ultrasound, CT and MR of the hepatobiliary system, the primary focus is still on plain films and barium studies. The quality of many of the ultrasound images is poor and some clearly old. There is no consistency in displaying ultrasound, appearing variously as negative and positive images. Failure to include endoscopic ultrasound in the evaluation of oesophageal lesions in an oversight and there could be more attention given to endorectal scanning. There has been an attempt to integrate "scanning" into chapters but this has not been wholly successful. A typical example is the absence of a CT image in the chapter dealing with abnormalities of the ileocaecal valve.

In the chapter on small bowel obstruction, the author correctly points to the role of CT in the radiological investigation of small bowel obstruction. In the preceeding paragraph, the author dismisses the use of water-soluble contrast agents. Various publications, particularly in the surgical literature, advocate the use of a limited gastrografin study in equivocal cases, particularly where access to CT is limited. This approach is perhaps more pragmatic and has the advantage that it does not preclude the use of CT in the days following an inconclusive barium study.

The book contains an 83 page well-illustrated chapter on abdominal calcifications. This represents a comprehensive overview on the subject and for this chapter alone, is probably worth purchasing for a teaching department.

Despite these small reservations, I am happy to recommend this book, particularly for teaching establishments. The indexing and overall layout is good. While the pattern approach would not suit every radiologist (or radiographer) it does, as suggested in the preface, offer a "handy reference for the practicing radiologist and resident faced with the daily challenge of interpreting gastrointestinal examinations".

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