Background: Endoscopy and biopsy are used to diagnose celiac disease. There are however, observer dependent interpretations of the degree of villous atrophy in biopsies. We performed a pilot study using quantitative image processing procedures to quantify the degree of villous atrophy in patients with celiac disease.
Method: 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 to the blinded assessment of Marsh score for degree of villous atrophy.
Results: Mean E/P ratios for N=32 biopsy images: 2.76±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 nonparametric tests, E/P ratios were inversely correlated with the Marsh scores (Spearman’s coefficient ρ = 0.798, Kendall’s τ = -0.681; p<0.0001).
Conclusions: Biopsy images quantified by image analysis correlated exceedingly well with the histopathologic 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 standardization of histologic grading.