Unifying the seeds auto-generation (SAGE) with knee cartilage segmentation framework: data from the osteoarthritis initiative

  • Hong-Seng GanEmail author
  • Khairil Amir Sayuti
  • Muhammad Hanif Ramlee
  • Yeng-Seng Lee
  • Wan Mahani Hafizah Wan Mahmud
  • Ahmad Helmy Abdul Karim
Original Article



Manual segmentation is sensitive to operator bias, while semiautomatic random walks segmentation offers an intuitive approach to understand the user knowledge at the expense of large amount of user input. In this paper, we propose a novel random walks seed auto-generation (SAGE) hybrid model that is robust to interobserver error and intensive user intervention.


Knee image is first oversegmented to produce homogeneous superpixels. Then, a ranking model is developed to rank the superpixels according to their affinities to standard priors, wherein background superpixels would have lower ranking values. Finally, seed labels are generated on the background superpixel using Fuzzy C-Means method.


SAGE has achieved better interobserver DSCs of 0.94 ± 0.029 and 0.93 ± 0.035 in healthy and OA knee segmentation, respectively. Good segmentation performance has been reported in femoral (Healthy: 0.94 ± 0.036 and OA: 0.93 ± 0.034), tibial (Healthy: 0.91 ± 0.079 and OA: 0.88 ± 0.095) and patellar (Healthy: 0.88 ± 0.10 and OA: 0.84 ± 0.094) cartilage segmentation. Besides, SAGE has demonstrated greater mean readers’ time of 80 ± 19 s and 80 ± 27 s in healthy and OA knee segmentation, respectively.


SAGE enhances the efficiency of segmentation process and attains satisfactory segmentation performance compared to manual and random walks segmentation. Future works should validate SAGE on progressive image data cohort using OA biomarkers.


Seeds Automatic Random walks Knee cartilage segmentation 



The study is partially supported by the Fundamental Research Grant Scheme (FRGS) Grant No. FRGS/1/2018/ICT02/UNIKL/02/4 (Project title: Graph Transformed Deep ‘Interactive' Learning Framework in Medical Image Segmentation provided by the Malaysian Ministry of Education (MoE), Dana Penyelidikan Inovasi MARA (DPIM) Grant No. MARA/UNI/1/33/18/18(1) provided by Unit Penyelidikan & Inovasi MARA and Short Term Research Grant (STRG) Grant No. str17015 provided by Universiti Kuala Lumpur-British Malaysian Institute (UniKL-BMI).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2019

Authors and Affiliations

  1. 1.Medical Engineering Technology SectionUniversiti Kuala Lumpur, British Malaysian InstituteGombakMalaysia
  2. 2.Department of RadiologySchool of Medical Science, Universiti Sains MalaysiaKubang KerianMalaysia
  3. 3.Medical Devices and Technology Group (MEDITEG)Universiti Teknologi MalaysiaJohor BahruMalaysia
  4. 4.Department of Electronic Engineering Technology, Faculty of Engineering TechnologyUniversiti Malaysia PerlisArauMalaysia
  5. 5.Department of Electronic Engineering, Faculty of Electrical and Electronic EngineeringUniversiti Tun Hussein Onn MalaysiaBatu PahatMalaysia
  6. 6.Diagnostic Imaging ServicesKPJ Ipoh Specialist HospitalIpohMalaysia

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