TopoGate: Quality-Aware Topology-Stabilized Gated Fusion for Longitudinal Low-Dose CT New-Lesion Prediction

Low-dose computed tomography (LDCT) reduces radiation exposure but also introduces substantial noise and structural degradation, making it difficult to suppress noise without erasing subtle anatomical details. In this paper, we present TAFG-MAN, a latent diffusion framework for efficient and high-quality LDCT image denoising. The framework combines a perceptually optimized autoencoder, conditional latent diffusion restoration in a compact latent space, and a lightweight Timestep-Adaptive Frequency-Gated (TAFG) conditioning design. TAFG decomposes condition features into low- and high-frequency components, predicts timestep-adaptive gates from the current denoising feature and timestep embedding, and progressively releases high-frequency guidance in later denoising stages before cross-attention. In this way, the model relies more on stable structural guidance at early reverse steps and introduces fine details more cautiously as denoising proceeds, improving the balance between noise suppression and detail preservation. Experiments show that TAFG-MAN achieves a favorable quality-efficiency trade-off against representative baselines. Compared with its base variant without TAFG, it further improves detail preservation and perceptual quality while maintaining essentially the same inference cost, and ablation results confirm the effectiveness of the proposed conditioning mechanism.

Low-dose computed tomography (LDCT) reduces radiation exposure but introduces stronger quantum noise, streak artifacts, and local texture degradation, which can obscure anatomical boundaries and weaken low-contrast structures. Diffusion models are promising for LDCT denoising by progressively recovering normal-dose CT (NDCT) images from degraded LDCT inputs, but existing methods often suffer from insufficient anatomical guidance, uncertain frequency-dependent recovery, and uniform reverse-process modeling. We propose ProSAC-CT, a progressive spectral-anatomical co-guided multi-stage diffusion model for image-domain LDCT denoising. ProSAC-CT integrates an anatomical-prior-guided conditioning (APGC) module, a residual frequency-domain decoupling stage (RFDDS), and a time-step-decoupling denoising decoder (TD3). APGC extracts LDCT-derived structural guidance, RFDDS enhances frequency-aware representations, and TD3 assigns them to different reverse-diffusion stages for anatomical stabilization, boundary refinement, and fine-detail recovery. Experiments on four LDCT degradation benchmarks show that ProSAC-CT improves image fidelity, structural similarity, perceptual quality, and information preservation over representative methods while better preserving boundary-sensitive anatomical details. Downstream anatomical-region classification on Mayo-2020 further indicates that ProSAC-CT retains task-relevant anatomical information, supporting its practical use for low-dose CT denoising.

Automated CT triage requires models that are simultaneously accurate across diverse pathologies and reliable under institutional shift. While Vision Transformers provide strong visual representations, many clinically significant findings are defined by quantitative imaging biomarkers rather than appearance alone. We introduce JANUS, a physiology-guided dual-stream architecture that conditions visual embeddings on macro-radiomic priors via Anatomically Guided Gating. On the MERLIN test set (N=5082), JANUS attains macro-AUROC 0.88 and AUPRC 0.74, outperforming all reproduced baselines. It generalizes to an external dataset N=2000; AUROC 0.87), with the largest gains on findings defined by size and attenuation as well as improved calibration on both datasets. We further quantify prediction suppression using the Physiological Veto Rate (PVR), showing that under domain shift JANUS reduces high-confidence false positives substantially more often than true positives. Together, these results are consistent with physically grounded conditioning that improves both discrimination and reliability in CT triage. Code is made publicly available at github repository https://github.com/lavsendahal/janus and model weights are at https://huggingface.co/lavsendahal/janus.