Robust automated organ segmentation is a prerequisite for computer-aided diagnosis (CAD), quantitative imaging analysis and surgical assistance. For high-variability organs such as the pancreas, previous approaches report undesirably low accuracies. We present a bottom-up approach for pancreas segmentation in abdominal CT scans that is based on a hierarchy of information propagation by classifying image patches at different resolutions; and cascading superpixels. There are four stages: 1) decomposing CT slice images as a set of disjoint boundary-preserving superpixels; 2) computing pancreas class probability maps via dense patch labeling; 3) classifying superpixels by pooling both intensity and probability features to form empirical statistics in cascaded random forest frameworks; and 4) simple connectivity based post-processing. The dense image patch labeling are conducted by: efficient random forest classifier on image histogram, location and texture features; and more expensive (but with better specificity) deep convolutional neural network classification on larger image windows (with more spatial contexts). Evaluation of the approach is performed on a database of 80 manually segmented CT volumes in six-fold cross-validation (CV). Our achieved results are comparable, or better than the state-of-the-art methods (evaluated by leave-one-patient-out), with Dice 70.7% and Jaccard 57.9%. The computational efficiency has been drastically improved in the order of 6~8 minutes, comparing with others of ~10 hours per case. Finally, we implement a multi-atlas label fusion (MALF) approach for pancreas segmentation using the same datasets. Under six-fold CV, our bottom-up segmentation method significantly outperforms its MALF counterpart: (70.7 +/- 13.0%) versus (52.5 +/- 20.8%) in Dice. Deep CNN patch labeling confidences offer more numerical stability, reflected by smaller standard deviations.
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