X-ray microtomography imaging enables accurate visualization and quantification of the small-intestinal villi...

Vasculature of the small bowel mucosa, with a significant role in nutrient absorption and gut homeostasis, has been suggested to undergo remodeling in various gastrointestinal disorders, including celiac disease. However, due to its spatial organization within the mucosa, conventional 2D histological methods are of limited value in studying the intestinal vasculature reliably. X-ray microtomography (micro-CT) is a promising tool for soft tissue imaging, as it enables digital 3D reconstruction of various tissue samples, including endoscopically obtained small-bowel mucosal biopsies. In this proof-of-concept study, we utilize micro-CT imaging combined with iodine staining in revealing the 3D mucosal microvascular structures using celiac disease as a model. Furthermore, we present a unique image analysis workflow that enables the quantification of the microvascular network with explanatory parameters in untreated and treated celiac disease patients as well as in non-celiac disease controls. The calculation of these parameters has been unachievable previously using 2D image processing methods. The workflow produced results that showed noticeable differences in the microvascular structures from the point of diagnosis to after treatment. This unique method has potential to be used with various intestinal diseases and other applications where the mucosal vascular structures need to be visualized.