title: Quantitative assessment of endoscopic images for degree of villous atrophy in celiac disease.
abstract: BACKGROUND
  The degree of villous atrophy in celiac disease is difficult to assess at endoscopy. We sought to develop a quantitative technique for the evaluation of villous atrophy in endoscopic images.
  
  
  METHODS
  In ten celiac patients as identified by standard endoscopy with biopsy, and ten control patients, standard and videocapsule endoscopic images of the duodenum were digitized. Subimages 7.5 × 7.5 mm(2) in area from random locations within each image were assessed by measuring the length of mucosal fissures per unit area (L), and correlating L with the histologic grade of villous atrophy as determined by modified Marsh criteria.
  
  
  RESULTS
  Mean L values for standard endoscopic images were 37.8, 43.3, 64.1, and 83.5 mm for Marsh grades II, IIIa, IIIb, and IIIc, respectively. Mean L values for videocapsule images were 49.1, 50.0, 64.7, and 72.4 mm for Marsh grades II, IIIa, IIIb, and IIIc, respectively. Significant differences in the means existed between celiac images (Marsh scores II-IIIc) versus controls (p < 0.001) for both endoscopic and videocapsule images. There were no significant differences between measurements obtained from endoscopic versus videocapsule images.
  
  
  CONCLUSIONS
  Quantified image analysis correlates with the histologic grade of villous atrophy, is automated, and lacks observer bias, thus lending itself to standardization.
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. ciaccio@columbia.edu
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Ciaccio
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.forename: Christina A
authors.initials: CA
authors.lastname: Tennyson
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Lewis
authors.forename: Lincoln
authors.initials: L
authors.lastname: Hernandez
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
mesh_terms: D001284:Atrophy / Q000473:pathology; D053705:Capsule Endoscopes; D002446:Celiac Disease / Q000473:pathology*; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007413:Intestinal Mucosa / Q000473:pathology; D008871:Microvilli / Q000473:pathology; D012189:Retrospective Studies