CECT-Mamba: a Hierarchical Contrast-enhanced-aware Model for Pancreatic Tumor Subtyping from Multi-phase CECT

Contrast-enhanced computed tomography (CECT) is the primary imaging technique that provides valuable spatial-temporal information about lesions, enabling the accurate diagnosis and subclassification of pancreatic tumors. However, the high heterogeneity and variability of pancreatic tumors still pose substantial challenges for precise subtyping diagnosis. Previous methods fail to effectively explore the contextual information across multiple CECT phases commonly used in radiologists' diagnostic workflows, thereby limiting their performance. In this paper, we introduce, for the first time, an automatic way to combine the multi-phase CECT data to discriminate between pancreatic tumor subtypes, among which the key is using Mamba with promising learnability and simplicity to encourage both temporal and spatial modeling from multi-phase CECT. Specifically, we propose a dual hierarchical contrast-enhanced-aware Mamba module incorporating two novel spatial and temporal sampling sequences to explore intra and inter-phase contrast variations of lesions. A similarity-guided refinement module is also imposed into the temporal scanning modeling to emphasize the learning on local tumor regions with more obvious temporal variations. Moreover, we design the space complementary integrator and multi-granularity fusion module to encode and aggregate the semantics across different scales, achieving more efficient learning for subtyping pancreatic tumors. The experimental results on an in-house dataset of 270 clinical cases achieve an accuracy of 97.4% and an AUC of 98.6% in distinguishing between pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumors (PNETs), demonstrating its potential as a more accurate and efficient tool.