Validation of the X-ray microtomography in the assessment of duodenal morphometry and surface area in celiac disease

Johannes Virta; Markus Hannula; Katri Lindfors; Ilmari Tamminen; Juha Taavela; Heini Huhtala; Katri Kaukinen; Päivi Saavalainen; Jari Hyttinen; Kalle Kurppa

doi:10.3389/fimmu.2022.945197

Validation of the X-ray microtomography in the assessment of duodenal morphometry and surface area in celiac disease

Front Immunol. 2022 Sep 23:13:945197. doi: 10.3389/fimmu.2022.945197. eCollection 2022.

Authors

Johannes Virta^{1

2}, Markus Hannula³, Katri Lindfors⁴, Ilmari Tamminen³, Juha Taavela⁴, Heini Huhtala⁵, Katri Kaukinen^{4

6}, Päivi Saavalainen⁷, Jari Hyttinen³, Kalle Kurppa^{1

2

4

8}

Affiliations

¹ Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
² Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
³ Computational Biophysics and Imaging Group, The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁴ Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁵ Faculty of Social Sciences, Tampere University, Tampere, Finland.
⁶ Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
⁷ Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.
⁸ The University Consortium of Seinäjoki and Seinäjoki Central Hospital, Seinäjoki, Finland.

Abstract

Background: Duodenal histology remains the diagnostic reference standard in celiac disease. However, traditional methods have suboptimal sensitivity and reproducibility for early mucosal changes and research purposes. We validated a recently introduced micro-CT imaging method for an accurate digital evaluation of duodenal histomorphometry and mucosal surface areas.

Methods: Endoscopic biopsies from 58 individuals were utilized for the micro-CT imaging, selecting histological changes ranging from normal to severely damaged mucosa. The imaging protocol was optimized for practicability and resolution. The Bland-Altman method was applied to test intra- and interobserver variations in the blinded measurements.

Results: The 3D micro-CT reconstructions enabled easy and precise digital cutting with optimal orientation and computer-assisted measurement of the surface area. Intraobserver analysis of morphological measurements showed a mean difference of 0.011 with limits of agreement (LA) from -0.397 to 0.375 and a standard deviation (SD) of 0.197. The corresponding figures for interobserver analysis were 0.080, from -0.719 to 0.537 and 0.320, respectively. The intraclass correlation coefficients (ICC) for the intraobserver and interobserver variations were 0.981 and 0.954, respectively. Intraobserver surface area analysis yielded a mean difference of 0.010, LA from -0.764 to 0.785 and an SD of 0.395, and an interobserver analysis mean difference of 0.028, LA from -0.642 to 0.698 and SD of 0.342. The respective ICCs for the intra- and interobserver variations were 0.963 and 0.972.

Conclusions: Micro-CT showed excellent accuracy and reproducibility in the evaluation of mucosal morphometry and surface areas. The improved sensitivity for histological changes is a powerful tool for the diagnosis of celiac disease and for clinical and pharmacological studies.

Keywords: biopsies; celiac disease; diagnosis; histology; imaging; micro-CT.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Celiac Disease* / diagnostic imaging
Celiac Disease* / pathology
Duodenum / diagnostic imaging
Humans
Observer Variation
Reproducibility of Results
X-Ray Microtomography