Remedios, Lucas W.; Cho, Chloe; Schwartz, Trent M.; Su, Dingjie; Rudravaram, Gaurav; Gao, Chenyu; Krishnan, Aravind R.; Saunders, Adam M.; Kim, Michael E.; Bao, Shunxing; Lasko, Thomas A.; Powers, Alvin C.; Landman, Bennett Allan; & Virostko, John M. (2026). Lifespan pancreas morphology for control versus type 2 diabetes using AI on largescale clinical imaging. Clinical Anatomy. Advance online publication. https://doi.org/10.1002/ca.70077
Understanding how the pancreas normally changes in size and shape from infancy through old age is important for recognizing abnormal changes linked to type 2 diabetes and other pancreatic diseases. In this study, we measured pancreas morphology (size and shape) across the lifespan, from birth to age 90. Our goals were to identify reliable imaging methods for artificial intelligence (AI)-based pancreas measurement, establish normal aging patterns, and determine how type 2 diabetes may alter these patterns.
We analyzed abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans from 2,533 patients who did not have cancer, pancreatic disease, sepsis, or trauma. The scans were standardized to the same resolution, and the pancreas was automatically segmented using AI-based methods. We then extracted 13 morphological features of the pancreas.
First, we compared pancreas volume trends across contrast CT, non-contrast CT, and MRI in 1,858 control patients to determine which imaging method produced the most consistent lifespan patterns. CT was selected for the main analyses because MRI measurements differed when processed with our AI method in this clinical dataset. Next, we established normative aging patterns in pancreas morphology by age group and sex. Finally, we used statistical modeling (GAMLSS regression) to compare 675 patients with type 2 diabetes to 675 age- and sex-matched non-diabetic controls.
After adjusting for other factors, 10 of the 13 morphological features showed significantly different aging trends in people with type 2 diabetes compared to controls. Overall, the pancreas was smaller in individuals with type 2 diabetes, confirming previous findings. This study provides a large clinical reference of normal pancreas morphology across the lifespan and shows how type 2 diabetes is associated with measurable changes in pancreas size and shape.
FIGURE 1
The pancreas undergoes structural changes with age, including atrophy and fat infiltration. While population-level pancreas volume and fat content have been examined across the aging process (Saisho et al. 2007), there remains a knowledge gap in understanding age-related changes in the pancreas across a broader set of morphological measurements. Moreover, type 2 diabetes may cause changes in pancreas morphology that differ from normal aging. The two scans on the left illustrate age-related appearance differences in non-diabetic patients but are not from the same patient. The rightmost scan shows the pancreas from an elderly patient with type 2 diabetes. Understanding pancreas variation in normal aging is critical for understanding differences in type 2 diabetes. Any potential differences in the aging trends of the pancreas in type 2 diabetes may not necessarily be linear or smooth.