Iodine-enhanced x-ray phase-contrast CT for three-dimensional virtual histopathology evaluation of human cirrhosis

Cirrhosis is the leading cause of liver disease-related morbidity and mortality worldwide. The destruction and remodeling of fibrous tissue, regenerated nodules, and microvascular system are the key pathological changes in the course of cirrhosis. Therefore, comprehensive visualization and analysis of the three-dimensional (3D) morphology of these characteristic structures using an appropriate imaging technique can provide a new approach for deep understanding of the spatial pathology of cirrhosis.

To realize 3D virtual histopathology assessment of key microscopic structures of representative cirrhosis, such as biliary cirrhosis, hepatitis B cirrhosis (Hep B-cirrhosis), and alcoholic cirrhosis via iodine-enhanced x-ray phase-contrast CT (PCCT).

Ten patients with biliary cirrhosis, 10 patients with Hep B-cirrhosis and 6 patients with alcoholic cirrhosis were included in the study. The integrated 3D virtual histopathology evaluation system of human cirrhosis was constructed through sample collection, iodine staining, PCCT imaging, 3D reconstruction, and quantitative evaluation. 3D observation and quantitative evaluation of key pathological anatomical structures, such as fibrous tissues, regenerated nodules, and microvascular system, were realized in all patients with cirrhosis through the 3D virtual histopathology evaluation system.

3D co-construction and spatial anatomy of fibrous tissues, regenerated nodules, and microvascular structure in patients with biliary cirrhosis, Hep B-cirrhosis, and alcoholic cirrhosis were performed by iodine-stained 3D virtual histopathology technology, which can be virtually sliced at any point and in any direction. Further 3D quantitative evaluation revealed: the fibrosis volume ratio in biliary cirrhosis, Hep B-cirrhosis, and alcoholic cirrhosis was 24.95 ± 6.06 %, 11.34 ± 5.05%, and 15.27 ± 6.77%, respectively. The nodule volume in the three types of cirrhosis was 5.66 × 10⁸ ± 4.27 × 10⁸ µm³, 7.73 × 10⁹ ± 1.88 × 10⁹ µm³, and 1.36 × 10⁹ ± 7.71 × 10⁸ µm³ respectively, and the septal thickness was 347.19 ± 128.49, 184.06 ± 70.84, and 134.77 ± 41.64 µm, respectively. In addition, the pseudo-lobule and single nodule structure of cirrhosis can be observed with high precision in 3D.

A 3D digital pathological database of cirrhosis containing various microscopic structures and key pathological features can be established through the integrated virtual histopathology evaluation system, strengthening the arsenal of research instrumentation available for section-free virtual pathology of cirrhosis.