# Deep Learning-Based Segmentation of Peritoneal Cancer Index Regions from CT Imaging

arXiv: https://arxiv.org/abs/2604.27697 · HTML: https://mlsanity.com/paper/2604.27697/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 5 of its 15 references that are in the map.
- First posted on arXiv 30 Apr 2026.

## Builds on (most cited first, 5 of 5)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [nnU-Net: Self-adapting Framework for U-Net-Based Medical Image Segmentation](https://mlsanity.com/paper/1809.10486/) (2018)

## Built on by (most cited first, 1 of 1)

- [Evaluating the Effects of Inter-Observer and Model Variability on Radiological Peritoneal Cancer Index Assessment](https://mlsanity.com/paper/2608.28716/) (2026)

## Abstract (arXiv)

Peritoneal metastases (PM) are staged using the surgically determined Peritoneal Cancer Index (sPCI), which requires invasive laparoscopic assessment. Although CT is routinely used for preoperative evaluation, imaging-based assessment of PM extent remains challenging and is often less structured than surgical PCI scoring. A recent consensus study defined radiological PCI (rPCI) regions for cross-sectional imaging. We present the first deep learning approach to automatically segment 13 rPCI regions on CT. 62 contrast-enhanced CT scans were retrospectively collected across the full PCI range. Each scan was annotated into non-overlapping rPCI regions by one researcher, reviewed by a second, with disagreements resolved by a radiologist. Using five-fold cross-validation, we compared nnU-Net and Swin UNETR with Dice, 95th-percentile Hausdorff distance (HD95) and Average Surface Distance (ASD). We introduce an anatomically constrained pipeline that trains on merged super-regions and splits them during post-processing using TotalSegmentator landmarks at the hips and the ligament of Treitz. On this 62-scan cohort, the baseline nnU-Net reached an overall Dice of 0.81 and outperformed Swin UNETR (0.76). The proposed pipeline improved the overall Dice to 0.84 and reduced boundary error (HD95 13.7 to 11.8 mm; ASD 4.1 to 3.4 mm), with the largest gains in the small-bowel regions, approaching the interobserver Dice of 0.87. Automated rPCI region segmentation on CT is feasible and approaches interobserver agreement. Encoding anatomical boundary constraints substantially improves segmentation quality in the most challenging regions. This provides a reproducible foundation for non-invasive, imaging-based PCI assessment. The main limitations are the single-center cohort and the small interobserver subset.