Semiautomatic Evaluation of Crypt Architecture and Vessel Morphology in Confocal Microendoscopy: Application to Ulcerative Colitis

Neoangiogenesis plays a central role in both the initiation and perpetuation of the inflammatory response during chronic intestinal inflammation. However, limited data is available on the microvascular and crypt architecture during remission phases. In this study we have evaluated the intestinal mucosa of UC patients in clinical and endoscopic remission by probe-based confocal endomicroscopy (p-CLE) and quantified microvessel tortuosity and crypt architecture by a semiautomated analysis. The system firstly automatically identifies the crypts visible in the images, and estimates the graph connecting their centers in order to estimate the crypt architecture. Hyperfluorescence in the peri-crypt region is evaluated, and leakge is automatically detected. Length and tortuosity of the manually inserted vessels assess the vascular state. 6 patients with active UC and 2 with inactive UC were evaluated acquiring 19 set of p-CLE images with matched biopsies, showing significant differences in crypt architecture, vessel morphology and hyperfluorescence patterns.