Leveraging Image Editing Foundation Models for Data-Efficient CT Metal Artifact Reduction

In computed tomography imaging, metal implants frequently generate severe artifacts that compromise image quality and hinder diagnostic accuracy. There are three main challenges in the existing methods: the deterioration of organ and tissue structures, dependence on sinogram data, and an imbalance between resource use and restoration efficiency. Addressing these issues, we introduce MARMamba, which effectively eliminates artifacts caused by metals of different sizes while maintaining the integrity of the original anatomical structures of the image. Furthermore, this model only focuses on CT images affected by metal artifacts, thus negating the requirement for additional input data. The model is a streamlined UNet architecture, which incorporates multi-scale Mamba (MS-Mamba) as its core module. Within MS-Mamba, a flip mamba block captures comprehensive contextual information by analyzing images from multiple orientations. Subsequently, the average maximum feed-forward network integrates critical features with average features to suppress the artifacts. This combination allows MARMamba to reduce artifacts efficiently. The experimental results demonstrate that our model excels in reducing metal artifacts, offering distinct advantages over other models. It also strikes an optimal balance between computational demands, memory usage, and the number of parameters, highlighting its practical utility in the real world. The code of the presented model is available at: https://github.com/RICKand-MORTY/MARMamba.

An X-ray computed tomography (CT), metal artifact reduction (MAR) remains a major challenge because metallic implants violate standard CT forward-model assumptions, producing severe streaking and shadowing artifacts that degrade diagnostic quality. We propose MGMAR, a metal-guided MAR method that explicitly leverages metal-related information throughout the reconstruction pipeline. MGMAR first generates a high-quality prior image by training a conditioned implicit neural representation (INR) using metal-unaffected projections, and then incorporates this prior into a normalized MAR (NMAR) framework for projection completion. To improve robustness under severe metal corruption, we pretrain the encoder-conditioned INR on paired metal-corrupted and artifact-free CT images, thereby embedding data-driven prior knowledge into the INR parameter space. This prior-embedded initialization reduces sensitivity to random initialization and accelerates convergence during measurement-specific refinement. The encoder takes a metal-corrupted reconstruction together with a recursively constructed metal artifact image, enabling the latent field to capture metal-dependent global artifact patterns. After projection completion using the INR prior, we further suppress residual artifacts using a metal-conditioned correction network, where the metal mask modulates intermediate features via adaptive instance normalization to target metal-dependent secondary artifacts while preserving anatomical structures. Experiments on the public AAPM-MAR benchmark demonstrate that MGMAR achieves state-of-the-art performance, attaining an average final score of 0.89 on 29 clinical test cases.

CT vision-language foundation models have demonstrated promising performance across downstream tasks, but are typically trained with whole-volume representations that dilute fine-grained anatomical signals. Fine-grained vision-language pre-training addresses this by aligning anatomy-level visual features with anatomy-specific text, but in doing so discards the global context that whole-volume models provide. Furthermore, existing fine-grained approaches train from scratch, making them computationally expensive. We introduce Anatomy Contextualized Adaptation (ACA), a lightweight framework that adapts frozen CT foundation model representations for anatomy-level vision-language alignment while enhancing global contextualization. ACA uses TotalSegmentator to decompose CT volumes into anatomy-level embeddings, which are refined via a transformer that captures cross-anatomy relationships, and aligned to both per-anatomy and scan-level text extracted from radiology reports. Evaluated on Merlin and CT-RATE, ACA consistently outperforms both the frozen foundation model baselines and existing fine-grained methods in zero-shot finding classification, while requiring less than one hour of training once embeddings are cached. The attention weights learned by ACA's inter-anatomy transformer additionally indicate plausible cross-anatomy context routing. Altogether, these results support ACA as a lightweight approach for adapting CT foundation models to anatomically grounded vision-language alignment while preserving and enhancing global anatomical context.