Spectral CT quantification of organ mass and physical density: A non-invasive metric for assessing functional reserve in type 2 diabetes

Introduction: Conventional imaging fails to quantify the true physical density and mass of organs. This study aims to develop a spectral CT-based physical modeling approach to quantify organ remodeling in type 2 diabetes mellitus (T2DM). Methods: A total of 97 subjects (46 T2DM patients and 51 non-diabetic controls) were evaluated. Organ regions (liver, pancreas, spleen) were automatically segmented using a V-Net neural network. A physical density model was constructed based on spectral parameters. We compared organ CT value, effective atomic number, mass, volume, and physical density between groups and analyzed their correlation with HbA1c levels. Results: The physical density model showed high accuracy, with measured subcutaneous fat density aligning with standard physical references. In T2DM patients, pancreatic mass and physical density decreased significantly. Conversely, liver and spleen mass increased without significant changes in physical density. Pancreatic physical density showed a significant negative correlation with HbA1c, with rho = −0.411 and p < 0.001. Discussion: The spectral physical density model provides a precise, non-invasive metric for assessing organ quality. The strong correlation between pancreatic density and glycemic supports its potential utility in evaluating functional reserve for artificial organ.