Visionerves: Automatic and Reproducible Hybrid AI for Peripheral Nervous System Recognition Applied to Endometriosis Cases

Endometriosis often leads to chronic pelvic pain and possible nerve involvement, yet imaging the peripheral nerves remains a challenge. We introduce Visionerves, a novel hybrid AI framework for peripheral nervous system recognition from multi-gradient DWI and morphological MRI data. Unlike conventional tractography, Visionerves encodes anatomical knowledge through fuzzy spatial relationships, removing the need for selection of manual ROIs. The pipeline comprises two phases: (A) automatic segmentation of anatomical structures using a deep learning model, and (B) tractography and nerve recognition by symbolic spatial reasoning. Applied to the lumbosacral plexus in 10 women with (confirmed or suspected) endometriosis, Visionerves demonstrated substantial improvements over standard tractography, with Dice score improvements of up to 25% and spatial errors reduced to less than 5 mm. This automatic and reproducible approach enables detailed nerve analysis and paves the way for non-invasive diagnosis of endometriosis-related neuropathy, as well as other conditions with nerve involvement.