Utility of Pancreas Surface Lobularity as a CT Biomarker for Opportunistic Screening of Type 2 Diabetes

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disease that affects millions of people worldwide. Early detection is crucial as it can alter pancreas function through morphological changes and increased deposition of ectopic fat, eventually leading to organ damage. While studies have shown an association between T2DM and pancreas volume and fat content, the role of increased pancreatic surface lobularity (PSL) in patients with T2DM has not been fully investigated. In this pilot work, we propose a fully automated approach to delineate the pancreas and other abdominal structures, derive CT imaging biomarkers, and opportunistically screen for T2DM. Four deep learning-based models were used to segment the pancreas in an internal dataset of 584 patients (297 males, 437 non-diabetic, age: 45$\pm$15 years). PSL was automatically detected and it was higher for diabetic patients (p=0.01) at 4.26 $\pm$ 8.32 compared to 3.19 $\pm$ 3.62 for non-diabetic patients. The PancAP model achieved the highest Dice score of 0.79 $\pm$ 0.17 and lowest ASSD error of 1.94 $\pm$ 2.63 mm (p$<$0.05). For predicting T2DM, a multivariate model trained with CT biomarkers attained 0.90 AUC, 66.7\% sensitivity, and 91.9\% specificity. Our results suggest that PSL is useful for T2DM screening and could potentially help predict the early onset of T2DM.

Leveraging Anatomical Priors for Automated Pancreas Segmentation on Abdominal CT

An accurate segmentation of the pancreas on CT is crucial to identify pancreatic pathologies and extract imaging-based biomarkers. However, prior research on pancreas segmentation has primarily focused on modifying the segmentation model architecture or utilizing pre- and post-processing techniques. In this article, we investigate the utility of anatomical priors to enhance the segmentation performance of the pancreas. Two 3D full-resolution nnU-Net models were trained, one with 8 refined labels from the public PANORAMA dataset, and another that combined them with labels derived from the public TotalSegmentator (TS) tool. The addition of anatomical priors resulted in a 6\% increase in Dice score ($p < .001$) and a 36.5 mm decrease in Hausdorff distance for pancreas segmentation ($p < .001$). Moreover, the pancreas was always detected when anatomy priors were used, whereas there were 8 instances of failed detections without their use. The use of anatomy priors shows promise for pancreas segmentation and subsequent derivation of imaging biomarkers.