Deep learning accurately and reliably segments pelvic vascular structure in CT scans of gynecologic cancer patients

Introduction: Accurate identification of pelvic vascular structures is critical for safe and effective gynecologic cancer surgery, yet intraoperative recognition of the internal iliac artery, its branches, and corresponding venous pathways remains challenging due to complex anatomy and inter-individual variability. This study investigates the feasibility of fully automated, multi-class segmentation of both major pelvic vessels and smaller branches of the internal iliac artery and internal iliac vein using the nnU-Net v2 deep learning framework. Methods: Contrast-enhanced computed tomography angiography datasets from 47 patients were used for model training and evaluation. The nnU-Net v2 deep learning framework was employed to perform fully automated segmentation across nine vascular categories. These targets included major vessels, the internal iliac artery and vein, and an "other vessels" category consolidating surgically critical smaller branches, such as the obturator, uterine, and gluteal vessels. Model performance was quantitatively evaluated against ground truth annotations using the Dice Similarity Coefficient and Mean Surface Distance. Results: The model achieved high segmentation accuracy for large-diameter vessels such as the aorta and iliac arteries, with average Dice similarity coefficients exceeding 0.83 for arterial structures and 0.75 for venous structures. Smaller branches exhibited lower overlap scores but maintained anatomically coherent and clinically recognizable patterns, particularly for the obturator and gluteal arteries. Discussion: These findings demonstrate the potential of automated 3D vascular segmentation to enhance preoperative planning, anatomical education, and intraoperative safety in complex pelvic procedures. Furthermore, this represents the first systematic evaluation of the segmentation of major branches of the internal iliac artery in gynecologic oncology patients.