title: Quantitative assessment of the degree of villous atrophy in patients with coeliac disease.
abstract: BACKGROUND
  Endoscopy and biopsy are used to diagnose coeliac disease. There are, however, observer-dependent interpretations of the degree of villous atrophy in biopsies. A pilot study using quantitative image-processing procedures was performed to quantify the degree of villous atrophy in patients with coeliac disease.
  
  
  METHODS
  The degree of villous atrophy in duodenal biopsy images was quantified by calculating the ratio of villous edge-to-piecewise arc length (E/P ratio), and this value was compared with the blinded assessment of Marsh score for degree of villous atrophy.
  
  
  RESULTS
  Mean E/P ratios for n = 31 biopsy images, 2.76 (SD 0.44) (Marsh IIIa), 1.91 (0.50) (Marsh IIIb) and 1.18 (0.22) (Marsh IIIc), were significantly different (p = 0.006). Based on non-parametric testing, the E/P ratios were inversely correlated with Marsh scores (Spearman coefficient rho = -0.798, Kendall tau = -0.681; p<0.0001).
  
  
  CONCLUSIONS
  Biopsy images quantified by image analysis correlated exceedingly well with the histopathological grade of villous atrophy. Since quantified measurements are real-numbered values and lack observer bias, measurement of villous atrophy based on image analysis lends itself to standardisation of histological grading.
authors.affiliation: Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York 10032, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Ciaccio
authors.forename: G
authors.initials: G
authors.lastname: Bhagat
authors.forename: A J
authors.initials: AJ
authors.lastname: Naiyer
authors.forename: L
authors.initials: L
authors.lastname: Hernandez
authors.forename: P H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D001284:Atrophy; D002446:Celiac Disease / Q000473:pathology*; D004386:Duodenum / Q000473:pathology* / Q000648:ultrastructure; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007413:Intestinal Mucosa / Q000473:pathology* / Q000648:ultrastructure; D008871:Microvilli / Q000473:pathology; D010865:Pilot Projects