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Updated: Oct 9, 2025
3D Whole-heart Myocardial Tissue Analysis
Published on: April 12, 2017
3D virtual histopathology of cardiac tissue from Covid-19 patients based on phase-contrast X-ray tomography
Marius Reichardt1, Patrick Moller Jensen2, Vedrana Andersen Dahl2
1Institut für Röntgenphysik, Georg-August-Universität Göttingen, Friedrich-Hund-Platz, Göttingen, Germany.
Insights
Phase-contrast X-ray tomography revealed distinct vascular changes in cardiac tissue from COVID-19 patients. This advanced imaging technique identified intussusceptive angiogenesis, differentiating COVID-19 myocarditis from other viral causes.
Area of Science:
- Biomedical Imaging
- Pathology
- Cardiovascular Research
Background:
- COVID-19 can cause severe myocarditis with vascular complications.
- Conventional histopathology has limitations in fully characterizing 3D vascular changes.
- Understanding COVID-19 cardiac pathology is crucial for patient outcomes.
Purpose of the Study:
- To characterize the 3D structure of cardiac vascular tissue in COVID-19 patients using phase-contrast X-ray tomography.
- To quantify pathological changes in the vascular system and compare them to other viral myocarditis cases.
- To develop and apply automated methods for analyzing cardiac tissue structure.
Main Methods:
- Phase-contrast X-ray tomography was performed on cardiac samples from COVID-19 patients.
- A deep learning architecture (V-net) was used for 3D segmentation of the vascular network.
- Automated shape analysis using the structure tensor was implemented.
- High-resolution cone beam X-ray tomography and scanning electron microscopy were used for confirmation.
Main Results:
- Distinct pathological alterations in vessel diameter variation and micro-holes were observed in COVID-19 cardiac tissue.
- Evidence of increased intussusceptive angiogenesis was found.
- Automated analysis revealed that COVID-19 histopathology differs from influenza and coxsackie virus myocarditis.
Conclusions:
- Phase-contrast X-ray tomography provides novel insights into the 3D vascular pathology of COVID-19 myocarditis.
- The findings highlight unique vascular changes, including intussusceptive angiogenesis, in severe COVID-19.
- This advanced imaging approach can differentiate COVID-19 cardiac pathology from other viral myocarditis.
Abstract:
For the first time, we have used phase-contrast X-ray tomography to characterize the three-dimensional (3d) structure of cardiac tissue from patients who succumbed to Covid-19. By extending conventional histopathological examination by a third dimension, the delicate pathological changes of the vascular system of severe Covid-19 progressions can be analyzed, fully quantified and compared to other types of viral myocarditis and controls. To this end, cardiac samples with a cross-section of 3.5mm were scanned at a laboratory setup as well as at a parallel beam setup at a synchrotron radiation facility the synchrotron in a parallel beam configuration. The vascular network was segmented by a deep learning architecture suitable for 3d datasets (V-net), trained by sparse manual annotations. Pathological alterations of vessels, concerning the variation of diameters and the amount of small holes, were observed, indicative of elevated occurrence of intussusceptive angiogenesis, also confirmed by high-resolution cone beam X-ray tomography and scanning electron microscopy. Furthermore, we implemented a fully automated analysis of the tissue structure in the form of shape measures based on the structure tensor. The corresponding distributions show that the histopathology of Covid-19 differs from both influenza and typical coxsackie virus myocarditis.
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