Lifespan Pancreas Morphology for Control Versus Type 2 Diabetes Using AI on Largescale Clinical Imaging

Understanding how pancreas size and shape change with normal aging is critical for establishing a baseline to detect deviations in type 2 diabetes and other pancreatic disease. We measure pancreas size and shape using morphological measurements from early development through aging (ages 0-90). Our goals are to (1) identify reliable clinical imaging modalities for artificial intelligence (AI) based pancreas measurement, (2) establish normative morphological aging trends, and (3) detect potential deviations in type 2 diabetes. We analyzed a clinically acquired dataset of 2533 patients imaged with abdominal computed tomography (CT) or magnetic resonance imaging (MRI). The patients did not have cancer, pancreas pathology, sepsis, or trauma. We resampled the scans to 3 mm isotropic resolution, segmented the pancreas using automated methods, and extracted 13 morphological pancreas features across the lifespan. First, we assessed pancreas volume trajectories in 1858 control patients across contrast CT, non-contrast CT, and MRI to determine which modalities provide consistent lifespan trends. Second, we characterized distributions of normative morphological patterns stratified by age group and sex. Third, we used covariate-adjusted generative additive models for location, scale, and shape (GAMLSS) regression to model pancreas morphology trends in 1350 patients matched for age, sex, and type 2 diabetes status to identify any deviations from normative aging associated with type 2 diabetes. We selected CT for the main analyses of this study, since the MRI appeared to yield different pancreas measurements than CT using our AI-based method on this dataset of clinically acquired scans. When adjusting for confounders, the aging trends for 10 of 13 morphological features were significantly different between patients with type 2 diabetes and non-diabetic controls (p < 0.05 after multiple comparisons corrections). Additionally, we characterized normative morphological aging trends of the pancreas across 13 morphological measurements. We provide lifespan trends demonstrating that the size and shape of the pancreas are altered in type 2 diabetes using 675 control patients and 675 diabetes patients. Moreover, our findings reinforce that the pancreas is smaller in type 2 diabetes. Additionally, we contribute a reference of lifespan pancreas morphology from a large cohort of non-diabetic control patients in a clinical setting.