Semantic Context Forests for Learning-Based Knee Cartilage Segmentation in 3D MR Images

Purpose: To develop and evaluate cross-sequence transfer learning for automatic femoral cartilage segmentation, testing bidirectional transfer between dual-echo steady-state (DESS) and sagittal proton density-weighted 3D fast spin-echo (Cube) sequences. Materials and Methods: We optimized a modified 2D U-Net on 507 DESS images from the Osteoarthritis Initiative (OAI). We then established same-sequence baselines using subject-level cross-validation on a subset of 44 OAI DESS images and 44 Cube images acquired at the Istituto Ortopedico Rizzoli, Bologna, Italy. Each subset included 22 non-lesioned and 22 lesioned subjects. Finally, we performed transfer learning across sequences by fine-tuning the pretrained models on the target sequence with increasing training set sizes to study convergence, while keeping validation and test sets fixed. Segmentations were evaluated using Dice similarity coefficient (DSC) and average surface distance (ASD). Lesion effects were assessed with two-sided Mann-Whitney U tests with Bonferroni correction. Results: Same-sequence training yielded higher accuracy on DESS than Cube (DSC, $0.900$ vs $0.830$; $P < .001$). Cube-to-DESS transfer matched DESS performance (DSC, $0.903 \pm 0.032$ vs $0.900 \pm 0.027$), reaching a performance plateau at 9 training subjects. DESS-to-Cube yielded a lower combined DSC ($0.802 \pm 0.049$ vs $0.830 \pm 0.042$), reaching a plateau at 24 training subjects. Lesions did not affect DESS ($P \ge .39$) but reduced Cube accuracy (DSC, $0.805$ vs $0.856$; $P < .001$). Conclusion: Transfer learning across sequences can substantially reduce target-sequence annotation requirements for femoral cartilage segmentation, but performance is direction- and sequence-dependent, and the effects of lesions on segmentation may vary across MRI sequences.

Early osteoarthritis detection through quantitative MRI (qMRI) requires accurate cartilage and meniscus segmentation, traditionally necessitating time-consuming, costly 3D high-resolution Double Echo Steady-State (DESS) MRI scans. This study developed a multi-task conditional generative adversarial network (MT-cGAN) to simultaneously synthesize DESS-like images and segment tissues directly from qMRI echo images. This retrospective study evaluated 508 knee MRI volumes from 361 subjects (mean age: $40.4 \pm 12.2$ years; 179 female) across three cohorts. Ground truth segmentation masks were generated from DESS images using a pretrained model with manual correction, and $T_{1ρ}$ and $T_2$ maps were computed from magnetization-prepared angle-modulated partitioned $k$-space spoiled gradient echo snapshots (MAPSS) echo images. MT-cGAN was trained to jointly synthesize DESS-like images and segment cartilage and meniscus directly from echo images. Model performance was evaluated using Dice score for segmentation accuracy and coefficient of variation (CV) for $T_{1ρ}$ and $T_2$ quantification. MT-cGAN achieved the highest segmentation performance, mean Dice score 0.84 (range: 0.80--0.86) across all cartilage and meniscus compartments and significantly outperformed the state-of-the-art conditional GAN model with transfer learning (mean Dice, 0.82; $p < 0.001$, Wilcoxon signed-rank test). For relaxometry quantification, MT-cGAN demonstrated the highest consistency with the reference DESS protocol, yielding the lowest CV ($T_{1ρ}$: 1.84%, $T_2$: 1.81%). The proposed MT-cGAN accurately segmented cartilage and menisci while providing reliable $T_{1ρ}$ and $T_2$ quantification directly from echo images. By eliminating the need for separate morphological DESS scans, this workflow reduces required scan times to facilitate the clinical translation of qMRI.

Background: Large volumes of unlabeled knee MRI scans are available across repositories but remain insufficiently leveraged. We developed KneePreM, a knee-specific 3D self-supervised model, and evaluated transfer and label efficiency for classification and segmentation. Methods: A 3D U-Net masked autoencoder was pretrained on 19,011 unlabeled Osteoarthritis Initiative (OAI) MRI series from 4,791 participants. Downstream fine-tuning used full and reduced training sets for fastMRI+ two-label classification (1,172 examinations), Arthroscopic Partial Meniscectomy (APM) eight-target classification (1,716 examinations), SKM-TEA segmentation (155 examinations), and APM segmentation (25 examinations). Baselines were random initialization and SuPreM. Deployment workflow was implemented with a Model Context Protocol interface. Evaluation metrics included balanced accuracy, F1 score, ROC AUC, PR AUC, and Dice score. Statistical analysis used bootstrap confidence intervals and paired bootstrap tests for classification and Wilcoxon signed-rank tests for segmentation. Results: KneePreM achieved higher full-data macro ROC AUC than both baselines for fastMRI+ and APM (all p < .001). For fastMRI+ classification, KneePreM achieved a ROC AUC of 0.722 using 50% of the training data, exceeding both full-data baselines. In APM classification, KneePreM reached a ROC AUC of 0.740 with 70% of the data, matching the full-data random baseline and outperforming SuPreM. For SKM-TEA segmentation, its 70%-data Dice of 0.838 exceeded the full-data random baseline (0.835) and both same-budget comparators. In APM segmentation, its 75%-data Dice of 0.746 exceeded the full-data random baseline (0.731) and both same-budget comparators. Conclusion: KneePreM improves transfer performance and label efficiency across knee MRI classification and segmentation tasks, particularly when labeled training data are limited.