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Active\u2010learning nnU\u2010Net reduces manual labeling while maintaining accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>For automatic upper airway segmentation on free\u2010breathing cine 4D MRI using active learning and quantifying dynamic changes under two mouth positions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Type<\/jats:title>\n                    <jats:p>Prospective cross\u2010sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010four OSA (obstructive sleep apnea)\u2010free adults (28\u2009M\/56F; 18\u201380\u2009years; 33 with sleep\u2010related breathing symptoms). Segmentation performance was evaluated on an internal test set (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Fieldstrength\/Sequence<\/jats:title>\n                    <jats:p>3T, free\u2010breathing time\u2010resolved imaging with interleaved stochastic trajectories (TWIST) sequence under closed\u2010 and open\u2010mouth positions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Assessment<\/jats:title>\n                    <jats:p>Manual annotations by a technologist (radiologist\u2010verified) served as reference standard and training labels for an active\u2010learning nnU\u2010Net (68 training; four fixed validation). Total airway length, cross\u2010sectional area (CSA), and total airway volume were computed at each anatomical level and compared across mouth positions, sex, and sleep\u2010related symptom status, and independent predictors were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Statistical Tests<\/jats:title>\n                    <jats:p>\n                      Paired\/unpaired t or Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test (two\u2010sided\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). Predictor selection by 10\u2010fold LASSO; effects estimated via ordinary least squares with cluster\u2010robust standard errors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Segmentation achieved a dice 0.959\u2009\u00b1\u20090.019 (test set). Open\u2010mouth breathing significantly lengthened the total airway (7.92\u2009\u00b1\u20091.07 vs. 7.41\u2009\u00b1\u20090.93\u2009cm) and reduced retropalatal CSA (1.51\u2009\u00b1\u20090.68 vs. 1.80\u2009\u00b1\u20090.69\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ). Coefficients of variation (CVs) for CSA and volume were significantly higher with 20\u2010s open\u2010mouth breathing. Males (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928) exhibited significantly larger airway volumes than females (closed 27.94\u2009\u00b1\u20094.87 vs. 19.82\u2009\u00b1\u20093.26\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      ; open 30.26\u2009\u00b1\u20095.94 vs. 20.94\u2009\u00b1\u20093.85\u2009cm\n                      <jats:sup>3<\/jats:sup>\n                      ). Symptomatic individuals (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933) had significantly longer airways (closed 7.96\u2009\u00b1\u20090.96 vs. 7.04\u2009\u00b1\u20090.70\u2009cm; open 8.54\u2009\u00b1\u20091.01 vs. 7.52\u2009\u00b1\u20090.91\u2009cm), narrower open\u2010mouth retropalatal CSA (1.24\u2009\u00b1\u20090.51 vs. 1.68\u2009\u00b1\u20090.72\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ), and greater retropalatal CSA dynamic variability. Multivariable regression confirmed mouth position, symptoms, and sex as independent predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Conclusion<\/jats:title>\n                    <jats:p>Four\u2010dimensional cine MRI with active\u2010learning nnU\u2010Net can automatically quantify dynamic upper airway morphology, demonstrating systematic differences and dynamic variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence Level<\/jats:title>\n                    <jats:p>2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technical Efficacy<\/jats:title>\n                    <jats:p>Stage 2.<\/jats:p>\n                  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