Shet S, O’Shea OC, De Kock LGA, Kakish E, Lee RJ, Ni Chleirigh N, O’Broin E, Ryan DJ, Maher MM. Computed tomography derived morphomics in the prediction of long-term outcomes in acute pancreatitis. World J Radiol 2026; 18(7): 118613 [DOI: 10.4329/wjr.118613]
Corresponding Author of This Article
Ludolf Gavin Arthur De Kock, Lecturer, Researcher, Department of Radiology, School of Medicine, University College Cork, College Road, Cork T12 K8AF, Ireland. ldekock@ucc.ie
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Radiology, Nuclear Medicine & Medical Imaging
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research-article
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Shet S, O’Shea OC, De Kock LGA, Kakish E, Lee RJ, Ni Chleirigh N, O’Broin E, Ryan DJ, Maher MM. Computed tomography derived morphomics in the prediction of long-term outcomes in acute pancreatitis. World J Radiol 2026; 18(7): 118613 [DOI: 10.4329/wjr.118613]
World J Radiol. Jul 28, 2026; 18(7): 118613 Published online Jul 28, 2026. doi: 10.4329/wjr.118613
Computed tomography derived morphomics in the prediction of long-term outcomes in acute pancreatitis
Michael Martin Maher, David John Ryan, Evan O’Broin, Naomi Ni Chleirigh, Ronan James Lee, Eid Kakish, Ludolf Gavin Arthur De Kock, Orla Cliona O’Shea, Sahil Shet
Sahil Shet, Ludolf Gavin Arthur De Kock, Eid Kakish, Ronan James Lee, David John Ryan, Michael Martin Maher, Department of Radiology, School of Medicine, University College Cork, Cork T12 K8AF, Ireland
Sahil Shet, Ludolf Gavin Arthur De Kock, Eid Kakish, Ronan James Lee, Naomi Ni Chleirigh, David John Ryan, Michael Martin Maher, Department of Radiology, Cork University Hospital, Cork T12 DFK4, Ireland
Orla Cliona O’Shea, Evan O’Broin, School of Medicine, University College Cork, Cork T12 K8AF, Ireland
Author contributions: Shet S, Kakish E, Ryan DJ, and Maher MM designed the study; Shet S and Kakish E performed the morphomic measurements; Shet S and De Kock LGA performed the statistical analysis; Shet S, De Kock LGA, and Lee RJ drafted the manuscript; O’Shea OC, Ni Chleirigh N, and O’Broin E contributed to the data collection; and Ryan DJ and Maher MM contributed to the study design and critically revised the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (University College Cork), Nos. ECM 6 (n) 09/04/2024 & ECM 3 (j) 11/12/2025.
Informed consent statement: The requirement for informed consent was waived by the ethics committee because of the retrospective nature of the study and the use of existing clinical and imaging data with no direct patient contact.
Conflict-of-interest statement: The authors declare no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets generated and analysed during the current study are not publicly available due to institutional data protection and patient confidentiality requirements but are available from the corresponding author on reasonable request.
Corresponding author: Ludolf Gavin Arthur De Kock, Lecturer, Researcher, Department of Radiology, School of Medicine, University College Cork, College Road, Cork T12 K8AF, Ireland. ldekock@ucc.ie
Received: January 7, 2026 Revised: February 3, 2026 Accepted: June 30, 2026 Published online: July 28, 2026 Processing time: 198 Days and 20.4 Hours
Abstract
BACKGROUND
Acute pancreatitis is a common abdominal pathology with significant morbidity and mortality in select patients. Currently, prediction of outcome and prognosis in patients with acute pancreatitis is based on a variety of indices, scores, and criteria calculated from biochemical, clinical, and imaging parameters, but all currently available predictors of outcome have limitations. Analytic morphomics, a quantitative technique that assesses body composition from cross-sectional imaging, may offer a novel approach to outcome prediction.
AIM
To evaluate whether analytic morphomics-derived parameters can predict recurrence and mortality after an index episode of acute pancreatitis.
METHODS
Following ethical approval, a retrospective single-centre study was conducted at Cork University Hospital. Adult patients presenting with acute pancreatitis between January 2012 and December 2013 were included and followed for 10 years. Patients with pancreatic malignancy, equivocal diagnoses, or age < 18 years were excluded. Cases of acute pancreatitis were classified as acute interstitial oedematous pancreatitis or necrotising pancreatitis. Demographic, biochemical, and clinical data were collected, including the modified Glasgow Imrie severity score. Computed tomography examinations were analysed using CoreSlicer for semi-automated segmentation of skeletal muscle and adipose tissue at the L3 vertebral level. Statistical analysis was performed using Microsoft Excel and Jamovi, including the Mann-Whitney U test, Pearson correlation, and logistic regression.
RESULTS
Seventy-two patients were included with a median modified Glasgow Imrie severity score of 2. Wall muscle (WM) density correlated inversely with disease severity [WM density (Hounsfield units): r = -0.480, P < 0.001; psoas muscle density (Hounsfield units): r = -0.465, P < 0.001]. Higher WM density and greater subcutaneous fat (SCF) area were associated with reduced 30-day mortality (mean difference 14.4 HU, P = 0.003; 65.3 cm2, P = 0.033, respectively) and improved 10-year survival. On multivariate analysis, lower WM density and lower SCF area independently predicted short- and long-term mortality, while no morphomic variables were independently associated with recurrence.
CONCLUSION
Skeletal muscle quality and SCF are protective factors in acute pancreatitis. Integration of morphomics with existing severity scores may enhance prognostication. Larger studies are needed to validate these findings.
Core Tip: Computed tomography-derived analytic morphomics provide objective measures of body composition that can be extracted from routine imaging in acute pancreatitis. In this retrospective cohort with 10-year follow-up, higher skeletal muscle density and greater subcutaneous fat area were independently associated with reduced short- and long-term mortality, whereas other morphomic parameters were not independently associated with recurrence. These findings suggest that integrating computed tomography-based morphomic metrics with established clinical scoring systems may improve prognostic assessment in acute pancreatitis.
