Recent Advances in Hypothalamic Segmentation for Neuroimaging: A Comprehensive Review

The hypothalamus is a key structure in the human brain, comprising numerous functionally distinct subnuclei that regulate critical physiologic processes such as energy balance, stress response, and circadian rhythms. Due to the complexity and functional diversity of its subregions, precise segmentation is essential for elucidating its operational mechanisms. This review systematically summarizes hypothalamic segmentation methods and their applications in physiologic and clinical research. Current approaches are categorized into 2 complementary types: anatomy-based manual segmentation and deep learning-based fully automated segmentation. The former provides a standard for algorithm validation through expert knowledge, enabling accurate identification of key functional subregions; the latter offers an efficient solution for large-scale studies, facilitating in-depth exploration of the hypothalamus's heterogeneous functional architecture. The review also highlights major challenges in the field, including the lack of unified segmentation protocols-which hinders cross-study comparability-and a significant methodologic gap in pediatric population studies. Moving forward, it is crucial to establish standardized segmentation workflows, reduce subjective bias, improve reproducibility, and address the technical shortcomings in hypothalamic segmentation for children, thereby laying a foundation for comprehensively understanding the structure and function of this critical brain region.