  Purpose: To organize a knee MRI segmentation challenge for characterizing the
semantic and clinical efficacy of automatic segmentation methods relevant for
monitoring osteoarthritis progression.
  Methods: A dataset partition consisting of 3D knee MRI from 88 subjects at
two timepoints with ground-truth articular (femoral, tibial, patellar)
cartilage and meniscus segmentations was standardized. Challenge submissions
and a majority-vote ensemble were evaluated using Dice score, average symmetric
surface distance, volumetric overlap error, and coefficient of variation on a
hold-out test set. Similarities in network segmentations were evaluated using
pairwise Dice correlations. Articular cartilage thickness was computed per-scan
and longitudinally. Correlation between thickness error and segmentation
metrics was measured using Pearson's coefficient. Two empirical upper bounds
for ensemble performance were computed using combinations of model outputs that
consolidated true positives and true negatives.
  Results: Six teams (T1-T6) submitted entries for the challenge. No
significant differences were observed across all segmentation metrics for all
tissues (p=1.0) among the four top-performing networks (T2, T3, T4, T6). Dice
correlations between network pairs were high (>0.85). Per-scan thickness errors
were negligible among T1-T4 (p=0.99) and longitudinal changes showed minimal
bias (<0.03mm). Low correlations (<0.41) were observed between segmentation
metrics and thickness error. The majority-vote ensemble was comparable to top
performing networks (p=1.0). Empirical upper bound performances were similar
for both combinations (p=1.0).
  Conclusion: Diverse networks learned to segment the knee similarly where high
segmentation accuracy did not correlate to cartilage thickness accuracy. Voting
ensembles did not outperform individual networks but may help regularize
individual models.
