Characteristics of Blood Vessels in Female Genital Schistosomiasis: Paving the Way for Objective Diagnostics at the Point of Care

PLoS Negl Trop Dis. 2016 Apr 13;10(4):e0004628. doi: 10.1371/journal.pntd.0004628. eCollection 2016 Apr.

Abstract

Background: The mucosal changes associated with female genital schistosomiasis (FGS) encompass abnormal blood vessels. These have been described as circular, reticular, branched, convoluted and having uneven calibre. However, these characteristics are subjective descriptions and it has not been explored which of them are specific to FGS.

Methods: In colposcopic images of young women from a schistosomiasis endemic area, we performed computerised morphologic analyses of the cervical vasculature appearing on the mucosal surface. Study participants where the cervix was classified as normal served as negative controls, women with clinically diagnosed FGS and presence of typical abnormal blood vessels visible on the cervical surface served as positive cases. We also included women with cervical inflammatory conditions for reasons other than schistosomiasis. By automating morphological analyses, we explored circular configurations, vascular density, fractal dimensions and fractal lacunarity as parameters of interest.

Results: We found that the blood vessels typical of FGS are characterised by the presence of circular configurations (p < 0.001), increased vascular density (p = 0.015) and increased local connected fractal dimensions (p = 0.071). Using these features, we were able to correctly classify 78% of the FGS-positive cases with an accuracy of 80%.

Conclusions: The blood vessels typical of FGS have circular configurations, increased vascular density and increased local connected fractal dimensions. These specific morphological features could be used diagnostically. Combined with colourimetric analyses, this represents a step towards making a diagnostic tool for FGS based on computerised image analysis.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Blood Vessels / pathology*
  • Cervix Uteri / pathology*
  • Colorimetry / methods
  • Colposcopy
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Mucous Membrane / pathology*
  • Schistosomiasis haematobia / diagnosis*
  • Schistosomiasis haematobia / pathology*
  • South Africa
  • Young Adult

Grants and funding

The project received funding from the European Research Council under the European Union's Seventh Framework Programme, the University of Copenhagen with the support from the Bill and Melinda Gates Foundation, the Norwegian Research Council, the South-Eastern Regional Health Authority of Norway, the University of Oslo, Norway and Oslo University Hospital, Norway. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.