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Received March 15, 2020, accepted April 15, 2020, date of publication May 11, 2020

The accuracy and feasibility of skeletal muscle 
measured by semi-automatic three-dimensional MRI 
VOI method: A study using pig forelimbs 

By Q. Zhou, Q. Hu, X. Yang, Y. Chen, Y. Yu, J. Zhang, Q. Ma, G. Zhou, H. Wei, B. Zhang, H. Zhang  

Department of Radiology, The affiliated Jiangning hospital of Nanjing medical university, No.168, gushan Road, Nanjing, Jiangsu Province, China

ABSTRACT
Background and Objective: We aimed to assess and verify the measurement accuracy and feasibility of semi-automatic mag-
netic resonance imaging (MRI) volume of interest (VOI) method by comparing its measurements with actual skeletal muscle 
volumes and discuss the clinical significance.
Material and Methods: A total of 18 muscles from 2 pigs were measured by drainage method, VOI method (VVOI), the summa-
tion method (Vsum), and maximum section method (Vmax) respectively after MRI scanning. All measurements were performed 
by 2 musculoskeletal radiologists and repeated at 6 different times, recording the consuming time (minutes) of every muscle. 
The average result of the 2 radiologists was adopted. 
Results: The 3-D structure of the skeletal muscles was distinct and vivid. A Friedman test and the inter-class correlation coef-
ficient (ICC) indicated the VOI method had a high intra- and inter-reliability. The root mean square error (RMSE) over 6 time-
points was 1.101 mL. A Bland-Altman plot represented a superior consistency. Pairwise Mann–Whitney U testing demonstrated 
that the consuming time to measure each muscle by VOI method was short. 
Conclusions: The VOI method could semi-automatically display the 3-D reconstruct of the skeletal muscle clearly, conveniently, 
with a great accuracy, and high repeatability.

Keywords – Magnetic Resonance Imaging; Skeletal Muscle; Dimensional Measurement Accuracy; muscular atrophy; Pigs. 

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribution 4.0 International 
- CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original 
publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

INTRODUCTION
Age-related degeneration and some diseases can change 

skeletal muscle volume,1,2 especially in the upper limbs.3 
As the volume of muscle determines the maximal muscle 
force it can generate,4 upper limb muscle atrophy can lead 
to instability of the shoulder joint, causing secondary joint 
damage, physical disability, persistent arthralgia, and 

dysfunction.5–7 The volume of muscle is a predictor of poor 
outcomes, including mortality, disability, and poor quality 
of life.8 On the other hand, its morphological change is an 
important indicator for the development of competitive 
sports training programs, clinical evaluations, and research 
observation in orthopedics and sports medicine.9–11 Given 

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Zhou, Hu, Yang, Chen, Yu, J. Zhang, Ma, Zhou, Wei, B. Zhang, H. Zhang: Semi-automatic 3-D Reconstruction 
Measurement of Muscle Volume with Magnetic Resonance Imaging 

J Global Clinical Engineering Vol.2 Issue 3: 2020  16

the above, quantifying these features of the upper limb 
is important for providing context for healthy aging, 
musculoskeletal disorders, and is a functioning indicator 
whenever they occur in old or young patients.

 Magnetic resonance imaging (MRI) plays an impor-
tant role in evaluating muscle volume and displaying 3-D 
structure.12 Previous studies have reported the MRI 3-D 
reconstruction and volume measurement by delineat-
ing the contour manually.4,12–15 However, the manual 
operation was tedious and less reproducible. In methods 
such as deformation of a parametric specific object, the 
mean time for reconstruction was one hour.4 It has been 
reported that the volume of interest (VOI) method, a 
semi-automatic measurement based on routine MRI, can 
detect age-related degeneration and rotator cuff tear by 
measuring the deltoid muscle volume conveniently and 
directly.16 However, the accuracy and feasibility of the VOI 
method had not been verified, especially when its mea-
surements were compared to the actual muscle volumes.

Considering that it is unrealizable to compare the 
measurements with the actual muscle volumes of the 
living human body, the ethical problems and limited 
availability of cadaveric specimens rarely has research 
on human corpses been reported.17–19 Nevertheless, an 
animal model can easily solve the ethical problems and 
frozen tissue inactivation,20 and swine have proven to 
be an excellent alternative for practicing and simulating 
surgical strategies that cannot be performed on human 
cadavers.21,22 Therefore, the primary purpose of this study 
was to evaluate the accuracy and repeatability of MRI VOI 
method by comparing the data measured by VOI with 
the actual forelimbs' muscle volumes of pigs. We hypoth-
esized that the VOI method was accurate and reliable for 
measuring skeletal muscle volumes, and could provide a 
convenient and non-invasive way for clinical evaluation 
of sarcopenia or in orthopedics and sports medicine.

MATERIAL AND METHODS

Experimental Subject
The pig forelimbs for experiment 2 adult middle-aged 

female domestic pigs were bought from a pig farm where 
they were reared and slaughtered. The Animal Ethics 

Committee was provided with a waiver by our research 
ethics board. The 2 left forelimbs were transported to 
our hospital and received an MRI scan immediately after 
slaughtering. The period between slaughter and MRI scan 
was approximately 40 minutes. Freshness was maintained 
at 4° in transportation. We marked these 2 left forelimbs 
as pig forelimb 1 (PF 1, weight: 3.54Kg) and pig forelimb 
2 (PF 2, weight: 3.40Kg). 

MRI Scan 
MRI procedures were performed with a 3.0T MRI scan-

ner (Ingenia, Philips, Eindhoven, the Netherlands) using 
an16-channel Torso Coil. These 2 left forelimbs underwent 
the standard general clinical MRI protocol at our institu-
tion. T1-weighted turbo spin echo (TSE) imaging in the 
axial: repetition time (TR) = 627.0 ms, echo time (TE) = 
20 ms, slice thickness = 3 mm, interlamellar space = 0.3 
mm, number of excitations = 1, matrix size = 464 × 459; 
field of view (FOV) = 240 × 240 (mm), and the acquisi-
tion time of this sequence was 6 minutes and 24 seconds.

Drainage Method
After the MRI scanning, the 2 left forelimbs were dis-

sected immediately by 2 orthopedics doctors. Nine muscles 
were dissected from each skeleton, including extensor 
carpi radialis/ulnaris (ECR/ECU), extensor digitorum 
communis (EDC), flexor digitorum profundus caput 
humeral/ulnare (FDPCH/FDPCU), flexor carpi radialis/
ulnaris (FCR/FCU), flexor digitorum superficialis (FDS), 
and pronator teres (PT)23 Care was taken to ensure the 
entire muscle was removed from the skeleton. After dis-
section, excess connective tissue, tendons and fat were 
removed from the entire muscle. A total of 18 muscles 
are shown in Figure 1.

The actual volumes (Vact) of 18 muscles were mea-
sured by the drainage method. Figure 2 shows the detailed 
process. Vact was defined as the actual volume of the 
muscles. All readings were executed independently and 
high-resolution photos were taken horizontally by one of 
the musculoskeletal attending physicians. After the drain-
age test we checked the results with amplifying photos 
(Figure 2C), if inconsistent, the ultima Vact of muscle was 
determined by the high-resolution photos.



17 J Global Clinical Engineering Vol.2 Issue 3: 2020

Zhou, Hu, Yang, Chen, Yu, J. Zhang, Ma, Zhou, Wei, B. Zhang, H. Zhang: Semi-automatic 3-D Reconstruction 
Measurement of Muscle Volume with Magnetic Resonance Imaging 

Segmentation Principle of the VOI Method
A semi-automatic method to measure the muscle was 

applied (VOI method software uMR_770, united imaging 
healthcare, shanghai, China), which was still investigational. 
The algorithmic steps of the volume calculating method 
are presented in a compact form by the following:

a. Given the contours in slices that had been delin-
eated, contours in intermediate slices were calculated 
using shaped-based interpolation to maintain continuous 
transition.

1. Calculate the mask from the contour in slices and 
specify 1 inside the contour, while 0 outside.

2. Convert the mask into a gray-value image through 
a distance function.24

3. Estimate the contour in intermediate slices by 
interpolating the distance-representing gray-value 
slices and thresholding at zero.25

b. A horizontal scan line algorithm is applied to calcu-
late the internal area of the contour. For each scan line:

1. Find the intersections of the scan line with all edges 
of the polygon.

2. Sort the intersections by increasing x coordinate.
3. Find all pixels between pairs of intersections.
As the calculation of intersections was slow, edge 

coherence was considered to avoid unnecessary calcu-
lation, therefore Active Edge Table was adopted to store 
active edges related to the current scanline. The contour 
brings some ambiguity inevitably on whether the pixels 
should be treated as the interior of the polygon or not. Our 
criteria are that only pixels whose centers are interior to 
the polygon are counted. Therefore, the maximum error 
equals +/– the circumference of the contour multiplied 
by (largest pixel dimension) 2/2. To raise measurement 
accuracy, GUI (Graphical User Interface) and images are 
zoomed in to diminish ambiguousness.

c. The total areas were an accumulation of the areas 
in each slice. The volume equals the product of the ac-
cumulated area and the distance between the 2 slices’ 
center. The volume of a VOI was the product of the spac-
ing (normally the distance between 2 slices’ center) and 
the accumulated area of the VOI projected in each slice.

Image processing by VOI method
The axial T1-weighted TSE images of the 2 left forelimbs 

were passed to the local workstation, then the VOI method 
software was performed to reconstruct the skeletal muscle 
morphology of the pig forelimb and the volume of each 
muscle was individually measured semi-automatically. One 

FIGURE 1. A total of 18 muscles were placed on the operating 
table. The 9 muscles of the PF1 were displayed in the upper 
row, and the lower row placed the muscles of the PF2. 
ECR = extensor carpi radialis; EDC = extensor digitorum com-
munis; ECU = extensor carpi ulnaris; FDPCH = flexor digitorum 
profundus caput humerale; FDPCU = flexor digitorum profundus 
caput ulnare; FCU = flexor carpi ulnaris; FDS = flexor digitorum 
superficialis; FCR = flexor carpi radialis; PT = pronator teres; 
PF 1 = pig forelimb 1; PF 2 = pig forelimb 2.

FIGURE 2. A. Water was placed in a custom-made cylinder, 
waiting until the water does not flow out. B. The pronator teres 
was put into the cylinder cautiously and a small-scale gradu-
ated cylinder was used to measure the volume of water flowing 
from the cylinder. C. The lowest scale of the crescent was read 
horizontally and a high-resolution photo was taken to record 
the scale. The actual volume of pronator teres was 20.2 mm3.



Zhou, Hu, Yang, Chen, Yu, J. Zhang, Ma, Zhou, Wei, B. Zhang, H. Zhang: Semi-automatic 3-D Reconstruction 
Measurement of Muscle Volume with Magnetic Resonance Imaging 

J Global Clinical Engineering Vol.2 Issue 3: 2020  18

musculoskeletal attending physician and one musculoskel-
etal associate chief physician respectively identified every 
skeletal muscle and contour of the muscle. Only the first/
last slice, as well as the slice where the morphogenesis 
changes need to be delineated manually. The 3-D shape 
of every muscle was reconstructed and the volume was 
output automatically. The 2 operators repeated the above 
image processing 6 times every few days and recorded 
the entire process time (minutes). The average volume 
measured by these operators were taken as the result of 
the VOI method volume (VvoI).

Volume Measurement by Conventional Method
  Two musculoskeletal physicians measured all the 18 

muscles by the conventional method in picture archiving 
and communication system. The summation method 
volume (Vsum) showed the individual slice volumes, and 
is shown in Equation 1. The maximum section method 
volume (Vmax) was the largest interface to calculate the 
volume is shown in Equation 2. 

where α was the area per slice, αmax was the area of 
the maximum section, l was the slice thickness, ⅈ was 
the interlamellar space, and n was the number of slices. 
Repeated measuring 6 times at different times, record the 
measurements and the consuming time (minutes) of every 
muscle, adopt the average of the 2 physicians as the result.

Statistical analysis
Measurement data that conforms to a normal distribu-

tion were reported as mean ± standard deviation if not 
median was adopted. The intra-reliability in different time 
points were evaluated by Friedman test and inter-class 
correlation coefficient (ICC) was employed to evaluate 
the reliability of measurements between the 2 physicians. 
A Kruskal-Wallis H test was performed to compare the 
volumes and consume times in different measurement 
methods. Root mean square error (RMSE) was expressed as 
the difference between the 3 methods and the actual value. 
A Bland-Altman plot was applied to the data to display 

the distribution of measurements by various methods.  
A P value < 0.05 was considered statistically significant. 
Statistical analyses were performed with SPSS software 
version 21.0 (International Business Machines Corpora-
tion, Chicago Illinois, United States) and R program 3.5.0 
with calculation of a two-sided P value. All graphics were 
created using GraphPad Prism version 5.00 for Windows 
(GraphPad Software, San Diego California, United States).

RESULTS

3-D Reconstruction
The morphological structure and 3-D configuration of 

pig forelimbs from the reconstruction of MRI VOI method 
was distinct and vivid (Figure 3), with a high-resolution 
and was consistent with the known anatomy. 

Measurement Repeatability Verification

 A total of 18 pig forelimb muscles were measured 6 
times by 2 physicians using the MRI VOI method (Table 
1 and Table 2). A Friedman test showed the mean rank of 
all the 6 measurements had no statistical difference (χ2 
= 1.396, P = 0.925; χ2 = 9.38, P = 0.095, respectively), so 
there was a good reproducibility at different time points 
for one observer. The ICC value calculated from the mean 
measurement over all time points for each observer was 
close to 1 (ICC=0.999, 95% CI: 0.998~1.000). The above 
results indicated that the MRI VOI method demonstrated 
a high intra- and inter-reliability and good repeatability 
of volume measurements.

Equation 1

Equation 2

FIGURE 3.  A. The morphological structure and 3-D configura-
tion of pig forelimbs from the reconstruction of MRI VOI method 
was distinct and vivid. B. The cross-section images displayed 
different muscles using different colors and their volumes 
showed up automatically.



19 J Global Clinical Engineering Vol.2 Issue 3: 2020

Zhou, Hu, Yang, Chen, Yu, J. Zhang, Ma, Zhou, Wei, B. Zhang, H. Zhang: Semi-automatic 3-D Reconstruction 
Measurement of Muscle Volume with Magnetic Resonance Imaging 

Comparison of Measurement Accuracy 
The volumes of 18 muscles measured by drainage 

method, MRI VOI method and the other 2 conventional 
methods were shown in Table 3 (the results were the mean 
measurement of 6 times by 2 observers). The mean rank 

TABLE 1. The Volumes of 18 Muscles Measured Using VOI Method 6 Times By One Musculoskeletal Attending Physician and 
the Results of a Friedman Test

Muscles
Volumes (PF 1/PF 2, mm3)

mean χ2 P value
1 2 3 4 5 6

ECR 123.3/132.6 125.6/130.4 120.8/132.3 125.5/136.5 124.7/134.4 124.9/131.8 124.13/133.0 1.396 0.925

EDC 82.7/88.2 81.5/89.6 84.7/89.2 81.4/92.1 83.8/90.5 80.1/88.4 82.36/89.67

ECU 12.5/13.7 11.6/13.2 12.3/12.8 13.8/12.84 12.8/13.2 12.9/13.7 12.65/13.24

FDPCH 63.57/79.2 63.5/78.6 62.4/82.3 66.7/81.4 62.2/83.5 64.8/79.5 63.86/80.75

FDPCU 12.8/15.2 12.6/15.3 11.5/15.8 12.6/15.0 13.5/14.9 13.7/15.7 12.78/15.32

FCU 9.5/13 9.8/13.2 10.8/12.4 10.4/13.6 10.6/13.3 10.9/12.9 10.33/13.07

FDS 65.9/60.7 62.8/59.3 64.6/61.3 66.3/59.4 62.6/59.6 64.2/59.1 64.40/59.90

FCR 13.8/16.9 14.2/16.4 15.6/16.7 13.8/15.4 15.3/15.9 13.5/15.7 14.36/16.16

PT 17.7/24.6 18.1/24.7 19.5/24.1 18.7/23.4 19.6/24.3 18.2/25.1 18.63/24.37

ECR = extensor carpi radialis; EDC = extensor digitorum communis; ECU = extensor carpi ulnaris; FDPCH = flexor digitorum 
profundus caput humerale; FDPCU = flexor digitorum profundus caput ulnare; FCU = flexor carpi ulnaris; FDS = flexor digitorum 
superficialis; FCR = flexor carpi radialis; PT = pronator teres; PF 1 = pig forelimb 1; PF 2 = pig forelimb 2.

TABLE 2. The Volumes of 18 Muscles Measured Using VOI Method 6 Times By One Musculoskeletal Associate Chief Physician 
and the Results of a Friedman Test

Muscles
Volumes (PF 1/PF 2, mm3)

mean χ2 P value
1 2 3 4 5 6

ECR 124.6/130.8 125.8/131.6 125.3/135.4 122.7/133.66 125.1/134.5 124.6/134.8 124.96/133.45 9.38 0.095

EDC 84.6/87.6 86.7/88.7 87.2/86.5 86.9/88.4 85.3/88.9 84.6/89.3 85.95/88.23

ECU 12.6/12.4 12.7/12.7 12.4/10.0 12.3/11.9 11.9/12.4 13.2/11.9 12.53/11.88

FDPCH 66.2/77.7 65.4/78.3 67.8/79.31 66.9/78.4 64.8/77.3 65.5/78.3 65.92/78.22

FDPCU 13.7/15.6 14.6/15.3 14.5/16.71 13.8/14.5 14.2/15.8 13.4/16.2 13.95/15.69

FCU 10.9/12.5 10.6/12.4 10.7/13.55 11.3/11.7 10.8/12.2 10.9/11.9 11.25/12.38

FDS 61.9/58.3 62.4/58.4 63.2/61.25 62.8/57.3 61.6/57.6 62.4/57.7 62.42/58.43

FCR 14.8/16.9 15.2/16.8 15.3/15.88 14.7/16.3 15.7/16.5 15.6/16.5 15.28/16.48

PT 18.5/24.4 19.3/24.6 18.4/22.74 19.2/24.5 18.5/23.8 18.6/24.3 18.93/24.06

ECR = extensor carpi radialis; EDC = extensor digitorum communis; ECU = extensor carpi ulnaris; FDPCH = flexor digitorum 
profundus caput humerale; FDPCU = flexor digitorum profundus caput ulnare; FCU = flexor carpi ulnaris; FDS = flexor digitorum 
superficialis; FCR = flexor carpi radialis; PT = pronator teres; PF 1 = pig forelimb 1; PF 2 = pig forelimb 2.

of the 3 methods with Kruskal-Wallis H test were 28.50, 
29.06, and 24.94 respectively, χ2 was 0.724, P value was 
0.696, so no statistical difference existed among the 3 
methods.



Zhou, Hu, Yang, Chen, Yu, J. Zhang, Ma, Zhou, Wei, B. Zhang, H. Zhang: Semi-automatic 3-D Reconstruction 
Measurement of Muscle Volume with Magnetic Resonance Imaging 

J Global Clinical Engineering Vol.2 Issue 3: 2020  20

RMSE of 3 methods in 6 time points was 1.101 mL, 
1.523 mL, and 8.99 mL respectively. The RMSE between 
VVOI and Vact was the smallest of all, less than the RMSE 
of Vsum and Vact or the RMSE of Vmax and Vact. These 
data showed the VOI method has the highest accuracy 

while the maximum section method with the lowest 
accuracy. Bland-Altman plot represented the minimum 
bias of −0.2219 between VVOI and Vact (the other 2 were 
−0.5424 and 5.2162), equivalent to a superior consistency 
(Figure 4).

TABLE 3. The Average Volumes of 18 Muscles Measured by Three Methods and Its Actual Value

Volume (mm3)
PF 1                                                                                                     PF 2

Vact VVOI Vsum Vmax Vact VVOI Vsum Vmax 

ECR 124.0 124.545 125.80 98.91 133.0 133.225 137.23 111.35

EDC 85.0 84.155 83.17 77.27 89.0 88.95 88.96 74.52

ECU 13.0 12.59 12.62 11.34 11.5 12.56 11.12 10.54

FDPCH 65.0 64.89 66.95 63.50 78.0 79.485 78.79 72.26

FDPCU 13.2 13.365 14.13 10.52 15.6 15.505 15.25 14.70

FCU 11.6 10.79 10.56 8.94 10.4 12.725 13.45 10.58

FDS 61.5 63.41 60.98 62.28 57.5 59.165 57.93 53.10

FCR 16.4 14.82 16.43 16.11 16.0 16.32 16.66 12.92

PT 20.2 18.78 20.10 18.25 24.6 24.215 25.14 24.57

ECR = extensor carpi radialis; EDC = extensor digitorum communis; ECU = extensor carpi ulnaris; FDPCH = flexor digitorum 
profundus caput humerale; FDPCU = flexor digitorum profundus caput ulnare; FCU = flexor carpi ulnaris; FDS = flexor digitorum 
superficialis; FCR = flexor carpi radialis; PT = pronator teres; PF 1 = pig forelimb 1; PF 2 = pig forelimb 2.

FIGURE 4.  A Bland-Altman plot showed a comparison of the consistency of VVOI, Vsum and Vmax to Vact. The bias between VVOI and 
Vact was −0.2219, equivalent to a superior consistency.
VVOI = The volume of MRI VOI method; Vsum = The volume of the summation method; Vmax = The volume of the maximum section 
method; MD = mean value.

Measurement Consumption Time
The median consuming time to measure each muscle 

by the MRI VOI method, summation method, and the 
maximum section method was 1.07, 12.68 and 1.25 

minutes respectively. The consume time of the 3 methods 
exhibited significant differences by Kruskal-Wallis H test. 
Pairwise Mann–Whitney U test and P value adjustment by 
FDR method exhibited the summation method taken the 



21 J Global Clinical Engineering Vol.2 Issue 3: 2020

Zhou, Hu, Yang, Chen, Yu, J. Zhang, Ma, Zhou, Wei, B. Zhang, H. Zhang: Semi-automatic 3-D Reconstruction 
Measurement of Muscle Volume with Magnetic Resonance Imaging 

longest time (P = 0.00061), nevertheless, MRI VOI method 
and the maximum section method had no statistical dif-
ference (P = 0.2692).

DISCUSSION
The current examination for evaluating skeletal 

muscle volumes, includes bioimpedance analysis (BIA), 
ultrasound, dual-energy x-ray absorptiometry (DXA), 
computed tomography (CT), and MRI.26–30 Neverthe-
less, MRI has become the optimal method because of its 
non-invasiveness, high soft-tissue resolution, and 3-D 
configuration which could observe the morphological 
structure clearly and animatedly.4,31

In our study, the MRI VOI method was semi-automatic, 
merely to identify the interesting muscle and contour the 
enthesis of the muscle and slightly adjusted if the morphol-
ogy was irregular. The internal slices were measured and 
delineated by the computer automatically based on the 
signal intensity, and the organization loss of the internal 
slices was compensated through interpolation calcula-
tion. Its segmentation speed was rapid, and the median 
consume time to measure each muscle in this study was 
1.07 minutes, which was much shorter than the summa-
tion method volume (1.07 minutes vs. 12.68 minutes, P < 
0.001). For another, the pick-up algorithm of VOI method 
was not only based on the interaction and transformation 
detecting techniques, but also the visual characteristics. It 
was seldom influenced by the image noise, so the method 
could be performed on conventional MRI images and does 
not require high-resolution scanning, which would have 
a wider application. 

In this study 2 physicians completed the process inde-
pendently 6 times, the Friedman test and ICC showed a 
high intra- and inter-reliability, and a good repeatability of 
volume measurements. What's more, compared with the 
summation method and the maximum section method, the 
VOI method has the smallest RMSE, which approximated 
to the actual values (RMSE of 3 methods was 1.101 mL, 
1.523 mL, and 8.99 mL respectively).

The innovation of this research was that the accuracy 
of VOI method measurements was verified with the true 
muscle, which was more intuitive and credible. As the 
morphology and volume of the pig forelimb is similar to 

humans, using pig forelimbs in place of intravital human 
limbs could solve any ethical problems and reduce research 
costs.1 In the drainage method, several high-resolution 
photos were taken horizontally and rechecked by 2 observ-
ers (the photos were amplified and viewed repeatedly), 
which was conducive to collate the readings, ensure the 
results more veritably, and avoid errors. 

This current study has some limitations that should 
be considered. First, the sample capacity was low. Only 2 
left forelimbs (18 skeletal muscles) from 2 live domestic 
pigs were included in the study, although each method 
was measured 6 times using 3 methods. Second, although 
the pig forelimbs were similar in shape and nomenclature 
to the human upper limbs, there were some differences 
inevitably. Third, at present the VOI method software was 
still semi-automatic, in the future, an automatic component 
analysis through artificial intelligence will be realized, 
which could reduce the working hours greatly.

CONCLUSION
In summary, the 3-D reconstructs of MRI VOI method 

semi-automatically was used to display the morphologi-
cal structure of skeletal muscle. Compared with the real 
skeletal muscles, the VOI method has been verified to have 
great accuracy and high repeatability. Herein, this method 
can be employed as a clinical non-invasive evaluation tool 
for muscle atrophy such as sarcopenia, age-related degen-
eration, rotator cuff tears, or be used as an observation 
indicator in orthopedics and sports medicine.

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AUTHOR BIOGRAPHIES
Qing-Qing Zhou received a master’s degree in radiology 

with Nanjing Medical University, Nanjing, China, in 2018. 
She is currently a radiologist working in the Radiology 
Department of The Affiliated Jiangning Hospital of Nan-
jing Medical University. Research interests include deep 
learning in skeletal muscle system and its applications.


