Towards Accurate and Fast Clinical Body Composition: A Resource-Efficient Hierarchical Segmentation Framework for Multi-Source CT

Xiaodi Shen, Qingzhu Zheng, Yaoyang Qiu, Cien Fan, Ruonan Zhang, Yangdi Wang, Luyao Wu, Weikai Zheng, Longfei Zhao, Bing Li, Rulin Xu, Qiqi Xu, Ren Mao, Shiting Feng, Xuehua Li

Background: Automated 3D segmentation of muscles and adipose tissue from CT is vital for body composition analysis, but multi-source data heterogeneity and high CPU memory demands hinder clinical deployment. Methods: We propose a coarse-to-fine hierarchical framework to segment ten tissue structures. Efficiency is optimized using Dynamic Spacing and Anisotropic Patching, a Group Inference mechanism for low-memory sliding-window processing, and Topology-Aware Asymmetric Resampling for fast post-processing. Results: The framework was trained on 1,558 CT volumes from seven public and two private datasets, and evaluated on an independent test cohort (N=105), per-structure Dice coefficients ranged from 0.924 to 0.982. Eight major structures met the +-10% relative error clinical acceptance limit. On a 12-core CPU workstation, the GPU-free pipeline averaged 44.5 seconds per volume with 4.73 GB peak memory. Conclusion: This framework balances accuracy and efficiency, enabling robust, large-scale body composition analysis on standard CPU workstations.