Cerebral palsy is a neurological condition that is known to affect muscle growth.Detailed investigations of muscle growth require segmentation of muscles from MRI scans, which is typically done manually. In this study, we evaluated the performance of 2D, 3D, and hybrid deep learning models for automatic segmentation of 11 lower leg muscles and two bones from MRI scans of children with and without cerebral palsy. All six models were trained and evaluated on manually segmented T 1 -weighted MRI scans of the lower legs of 20 children, six of whom had cerebral palsy. The segmentation results were assessed using the median Dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and volume error (VError) of all 13 labels of every scan. The best performance was achieved by H-DenseUNet, a hybrid model (DSC 0.90, ASSD 0.5 mm, and VError 2.6 cm 3 ). The performance was equivalent to the inter-rater performance of manual segmentation (DSC 0.89, ASSD 0.6 mm, and VError 3.3 cm 3 ). Models trained with the Dice loss function outperformed models trained with the cross-entropy loss function. Near-optimal performance could be attained using only 11 scans for training. Segmentation performance was similar for scans of typically developing children (DSC 0.90, ASSD 0.5 mm, and VError 2.8 cm 3 ) and children with cerebral palsy (DSC 0.85, ASSD 0.6 mm, and VError 2.4 cm 3 ). These findings demonstrate the feasibility of fully automatic segmentation of individual muscles and bones from MRI scans of children with and without cerebral palsy.

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Semi-supervised learning has made significant progress in medical image segmentation. However, existing methods primarily utilize information acquired from a single dimensionality (2D/3D), resulting in sub-optimal performance on challenging data, such as magnetic resonance imaging (MRI) scans with multiple objects and highly anisotropic resolution. To address this issue, we present a Hybrid Dual Mean-Teacher (HD-Teacher) model with hybrid, semi-supervised, and multi-task learning to achieve highly effective semi-supervised segmentation. HD-Teacher employs a 2D and a 3D mean-teacher network to produce segmentation labels and signed distance fields from the hybrid information captured in both dimensionalities. This hybrid learning mechanism allows HD-Teacher to combine the 'best of both worlds', utilizing features extracted from either 2D, 3D, or both dimensions to produce outputs as it sees fit. Outputs from 2D and 3D teacher models are also dynamically combined, based on their individual uncertainty scores, into a single hybrid prediction, where the hybrid uncertainty is estimated. We then propose a hybrid regularization module to encourage both student models to produce results close to the uncertainty-weighted hybrid prediction. The hybrid uncertainty suppresses unreliable knowledge in the hybrid prediction, leaving only useful information to improve network performance further. Extensive experiments of binary and multi-class segmentation conducted on three MRI datasets demonstrate the effectiveness of the proposed framework. Code is available at https://github.com/ThisGame42/Hybrid-Teacher.