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

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          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.

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          Most cited references33

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          STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT

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            The intraclass correlation coefficient as a measure of reliability.

            J J Bartko (1966)
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              European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

              The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.
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                Author and article information

                Contributors
                Journal
                Front Immunol
                Front Immunol
                Front. Immunol.
                Frontiers in Immunology
                Frontiers Media S.A.
                1664-3224
                23 September 2022
                2022
                : 13
                : 945197
                Affiliations
                [1] 1 Tampere Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
                [2] 2 Department of Pediatrics, Tampere University Hospital , Tampere, Finland
                [3] 3 Computational Biophysics and Imaging Group, The Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
                [4] 4 Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
                [5] 5 Faculty of Social Sciences, Tampere University , Tampere, Finland
                [6] 6 Department of Internal Medicine, Tampere University Hospital , Tampere, Finland
                [7] 7 Department of Medical and Clinical Genetics, University of Helsinki , Helsinki, Finland
                [8] 8 The University Consortium of Seinäjoki and Seinäjoki Central Hospital , Seinäjoki, Finland
                Author notes

                Edited by: Marco Vincenzo Lenti, University of Pavia, Italy

                Reviewed by: Annalisa Schiepatti, Università degli Studi di Pavia, Italy; Mariantonia Maglio, University of Naples Federico II, Italy

                *Correspondence: Kalle Kurppa, kalle.kurppa@ 123456tuni.fi

                This article was submitted to Mucosal Immunity, a section of the journal Frontiers in Immunology

                Article
                10.3389/fimmu.2022.945197
                9539806
                e3d6b2f6-d037-4a78-b78c-6dea950e34a7
                Copyright © 2022 Virta, Hannula, Lindfors, Tamminen, Taavela, Huhtala, Kaukinen, Saavalainen, Hyttinen and Kurppa

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 16 May 2022
                : 01 September 2022
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 33, Pages: 8, Words: 3753
                Funding
                Funded by: Academy of Finland , doi 10.13039/501100002341;
                Funded by: Päivikki ja Sakari Sohlbergin Säätiö , doi 10.13039/501100004212;
                Funded by: Sigrid Juséliuksen Säätiö , doi 10.13039/501100006306;
                Funded by: Tekes , doi 10.13039/501100003406;
                Funded by: Lastentautien Tutkimussäätiö , doi 10.13039/501100005744;
                Funded by: Pirkanmaan Sairaanhoitopiiri , doi 10.13039/501100009960;
                Categories
                Immunology
                Original Research

                Immunology
                celiac disease,biopsies,histology,diagnosis,micro-ct,imaging
                Immunology
                celiac disease, biopsies, histology, diagnosis, micro-ct, imaging

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