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Anatomy-DT: A Cross-Diffusion Digital Twin for Anatomical Evolution

Accurately modeling the spatiotemporal evolution of tumor morphology from baseline imaging is a pre-requisite for developing digital twin frameworks that can simulate disease progression and treatment response. Most existing approaches primarily characterize tumor growth while neglecting the concomitant alterations in adjacent anatomical structures. In reality, tumor evolution is highly non-linear and heterogeneous, shaped not only by therapeutic interventions but also by its spatial context and interaction with neighboring tissues. Therefore, it is critical to model tumor progression in conjunction with surrounding anatomy to obtain a comprehensive and clinically relevant understanding of disease dynamics. We introduce a mathematically grounded framework that unites mechanistic partial differential equations with differentiable deep learning. Anatomy is represented as a multi-class probability field on the simplex and evolved by a cross-diffusion reaction-diffusion system that enforces inter-class competition and exclusivity. A differentiable implicit-explicit scheme treats stiff diffusion implicitly while handling nonlinear reaction and event terms explicitly, followed by projection back to the simplex. To further enhance global plausibility, we introduce a topology regularizer that simultaneously enforces centerline preservation and penalizes region overlaps. The approach is validated on synthetic datasets and a clinical dataset. On synthetic benchmarks, our method achieves state-of-the-art accuracy while preserving topology, and also demonstrates superior performance on the clinical dataset. By integrating PDE dynamics, topology-aware regularization, and differentiable solvers, this work establishes a principled path toward anatomy-to-anatomy generation for digital twins that are visually realistic, anatomically exclusive, and topologically consistent.

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