Letter to the Editor: comments on Reeves et al., 2016

I read with great interest the article by Reeves et al. published in the May issue of Brain Pathology (2016;26:319–333). Studies involving correlations of MRI, gross pathology and microscopic pathology are difficult and time‐consuming to perform. In general, the authors are to be commended on their illustrations of these comparisons. I was extremely disappointed when I came to Figure 6, which showed no obvious correspondence among the information represented in panels A (in vivo MRI), B (fixed tissue slice) and C, E, G (ex vivo MRI and immunohistochemistry), and no annotations to assist the reader. This made the entire figure difficult and time‐consuming to interpret. Panel A reportedly illustrates a right occipital “ulygyric” malformation. There is no annotation in the panel as to which is left and which is right. The convention for MRI images is to show the patient's right on the viewer's left. The hemisphere represented on the viewer's right shows low signal and paucity of white matter, a more complex gyral pattern than the opposite hemisphere and enlargement of the occipital horn of the lateral ventricle, so I conclude that the image was flipped horizontally, consistent with neuropathologist conventions for viewing brain slices. But this interpretation is confused by Panel B, which shows a portion of the fixed brain slice that was used for 9.4 T scanning. There is no indication of which side is medial and which is lateral. The left side of the image shows a cortical surface, which could be either medial or lateral. The right side shows a yellow cavity that I suspect represents the gliotic surface of an enlarged ventricular horn. There is no annotation in panel A to indicate where the region of interest in panel B was taken, and it is not easily recognized by comparison of the gyral patterns in the two panels. Similarly there is no annotation in panel B to indicate where the region of interest analyzed in panels C, E, and G was obtained. I have had extensive personal experience in research involving MRI/pathology correlations. I know how quickly gyral patterns can change as one sections deeper into tissue. This is all the more reason for authors to use annotations to facilitate interpretation by the readers. Reviewers and editors should also be especially attentive to these issues. No reader should have to put as much time and effort into interpreting a single figure as I have to do for Figure 6 of this paper. I suggest that a revised, clearly‐annotated figure be published.