title: Characteristics of Blood Vessels in Female Genital Schistosomiasis: Paving the Way for Objective Diagnostics at the Point of Care.
abstract: BACKGROUND
  The mucosal changes associated with female genital schistosomiasis (FGS) encompass abnormal blood vessels. These have been described as circular, reticular, branched, convoluted and having uneven calibre. However, these characteristics are subjective descriptions and it has not been explored which of them are specific to FGS.
  
  
  METHODS
  In colposcopic images of young women from a schistosomiasis endemic area, we performed computerised morphologic analyses of the cervical vasculature appearing on the mucosal surface. Study participants where the cervix was classified as normal served as negative controls, women with clinically diagnosed FGS and presence of typical abnormal blood vessels visible on the cervical surface served as positive cases. We also included women with cervical inflammatory conditions for reasons other than schistosomiasis. By automating morphological analyses, we explored circular configurations, vascular density, fractal dimensions and fractal lacunarity as parameters of interest.
  
  
  RESULTS
  We found that the blood vessels typical of FGS are characterised by the presence of circular configurations (p < 0.001), increased vascular density (p = 0.015) and increased local connected fractal dimensions (p = 0.071). Using these features, we were able to correctly classify 78% of the FGS-positive cases with an accuracy of 80%.
  
  
  CONCLUSIONS
  The blood vessels typical of FGS have circular configurations, increased vascular density and increased local connected fractal dimensions. These specific morphological features could be used diagnostically. Combined with colourimetric analyses, this represents a step towards making a diagnostic tool for FGS based on computerised image analysis.
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Sigve
authors.initials: S
authors.lastname: Holmen
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Hashini Nilushika
authors.initials: HN
authors.lastname: Galappaththi-Arachchige
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kleppa
authors.affiliation: Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa.
authors.forename: Pavitra
authors.initials: P
authors.lastname: Pillay
authors.affiliation: Optics and Imaging Centre, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Thajasvarie
authors.initials: T
authors.lastname: Naicker
authors.affiliation: Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Myra
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Department of Gynaecology, Oslo University Hospital, Oslo, Norway.
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.affiliation: Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway.|Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Eyrun Floerecke
authors.initials: EF
authors.lastname: Kjetland
authors.affiliation: Department of Informatics, University of Oslo, Oslo, Norway.|Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.
authors.forename: Fritz
authors.initials: F
authors.lastname: Albregtsen
mesh_terms: D000293:Adolescent; D000328:Adult; D001808:Blood Vessels / Q000473:pathology*; D002584:Cervix Uteri / Q000473:pathology*; D003124:Colorimetry / Q000379:methods; D003127:Colposcopy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009092:Mucous Membrane / Q000473:pathology*; D012553:Schistosomiasis haematobia / Q000175:diagnosis* / Q000473:pathology*; D013019:South Africa; D055815:Young Adult