# Probing the Limits and Capabilities of Diffusion Models for the Anatomic Editing of Digital Twins

arXiv: https://arxiv.org/abs/2401.00247 · HTML: https://mlsanity.com/paper/2401.00247/

## Key facts

- Cited by 6 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 19 of its 59 references that are in the map.
- First posted on arXiv 30 Dec 2023.

## Placed in

- Diffusion models / [Medical imaging and segmentation](https://mlsanity.com/diffusion/medical-imaging-and-segmentation/)

## Builds on (most cited first, 19 of 19)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [Score-Based Generative Modeling through Stochastic Differential Equations](https://mlsanity.com/paper/2011.13456/) (2020)
- [Classifier-Free Diffusion Guidance](https://mlsanity.com/paper/2207.12598/) (2022)
- [GLIDE: Towards Photorealistic Image Generation and Editing with Text-Guided Diffusion Models](https://mlsanity.com/paper/2112.10741/) (2021)
- [Elucidating the Design Space of Diffusion-Based Generative Models](https://mlsanity.com/paper/2206.00364/) (2022)
- [SDEdit: Guided Image Synthesis and Editing with Stochastic Differential Equations](https://mlsanity.com/paper/2108.01073/) (2021)
- [Diffusion Posterior Sampling for General Noisy Inverse Problems](https://mlsanity.com/paper/2209.14687/) (2022)
- [Improved Precision and Recall Metric for Assessing Generative Models](https://mlsanity.com/paper/1904.06991/) (2019)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [Solving Inverse Problems in Medical Imaging with Score-Based Generative Models](https://mlsanity.com/paper/2111.08005/) (2021)
- [Brain Imaging Generation with Latent Diffusion Models](https://mlsanity.com/paper/2209.07162/) (2022)
- [Mask, Stitch, and Re-Sample: Enhancing Robustness and Generalizability in Anomaly Detection through Automatic Diffusion Models](https://mlsanity.com/paper/2305.19643/) (2023)
- [Can segmentation models be trained with fully synthetically generated data?](https://mlsanity.com/paper/2209.08256/) (2022)
- [Diffusion Models for Counterfactual Generation and Anomaly Detection in Brain Images](https://mlsanity.com/paper/2308.02062/) (2023)
- [Learning Topological Interactions for Multi-Class Medical Image Segmentation](https://mlsanity.com/paper/2207.09654/) (2022)
- [Multitask Brain Tumor Inpainting with Diffusion Models: A Methodological Report](https://mlsanity.com/paper/2210.12113/) (2022)
- [CHeart: A Conditional Spatio-Temporal Generative Model for Cardiac Anatomy](https://mlsanity.com/paper/2301.13098/) (2023)
- [Generation of Structurally Realistic Retinal Fundus Images with Diffusion Models](https://mlsanity.com/paper/2305.06813/) (2023)

## Built on by (most cited first, 6 of 6)

- [A Diffusion Model for Simulation Ready Coronary Anatomy with Morpho-skeletal Control](https://mlsanity.com/paper/2407.15631/) (2024)
- [Cascaded 3D Diffusion Models for Whole-body 3D 18-F FDG PET/CT synthesis from Demographics](https://mlsanity.com/paper/2505.22489/) (2025)
- [CardioComposer: Leveraging Differentiable Geometry for Compositional Control of Anatomical Diffusion Models](https://mlsanity.com/paper/2509.08015/) (2025)
- [Denoising diffusion models for inverse design of inflatable structures with programmable deformations](https://mlsanity.com/paper/2508.13097/) (2025)
- [Anatomica: Localized Control over Geometric and Topological Properties for Anatomical Diffusion Models](https://mlsanity.com/paper/2511.20587/) (2025)
- [Flow-based conditional cardiac anatomy generation for virtual cohorts](https://mlsanity.com/paper/2608.09460/) (2026)

## Abstract (arXiv)

Numerical simulations can model the physical processes that govern cardiovascular device deployment. When such simulations incorporate digital twins; computational models of patient-specific anatomy, they can expedite and de-risk the device design process. Nonetheless, the exclusive use of patient-specific data constrains the anatomic variability which can be precisely or fully explored. In this study, we investigate the capacity of Latent Diffusion Models (LDMs) to edit digital twins to create anatomic variants, which we term digital siblings. Digital twins and their corresponding siblings can serve as the basis for comparative simulations, enabling the study of how subtle anatomic variations impact the simulated deployment of cardiovascular devices, as well as the augmentation of virtual cohorts for device assessment. However, while diffusion models have been characterized in their ability to edit natural images, their capacity to anatomically edit digital twins has yet to be studied. Using a case example centered on 3D digital twins of cardiac anatomy, we implement various methods for generating digital siblings and characterize them through morphological and topological analyses. We specifically edit digital twins to introduce anatomic variation at different spatial scales and within localized regions, demonstrating the existence of bias towards common anatomic features. We further show that such anatomic bias can be leveraged for virtual cohort augmentation through selective editing, partially alleviating issues related to dataset imbalance and lack of diversity. Our experimental framework thus delineates the limits and capabilities of using latent diffusion models in synthesizing anatomic variation for in silico trials.