Balancing Efficiency and Restoration: Lightweight Mamba-Based Model for CT Metal Artifact Reduction

Metal artifacts from high-attenuation implants severely degrade CT image quality, obscuring critical anatomical structures and posing a challenge for standard deep learning methods that require extensive paired training data. We propose a paradigm shift: reframing artifact reduction as an in-context reasoning task by adapting a general-purpose vision-language diffusion foundation model via parameter-efficient Low-Rank Adaptation (LoRA). By leveraging rich visual priors, our approach achieves effective artifact suppression with only 16 to 128 paired training examples reducing data requirements by two orders of magnitude. Crucially, we demonstrate that domain adaptation is essential for hallucination mitigation; without it, foundation models interpret streak artifacts as erroneous natural objects (e.g., waffles or petri dishes). To ground the restoration, we propose a multi-reference conditioning strategy where clean anatomical exemplars from unrelated subjects are provided alongside the corrupted input, enabling the model to exploit category-specific context to infer uncorrupted anatomy. Extensive evaluation on the AAPM CT-MAR benchmark demonstrates that our method achieves state-of-the-art performance on perceptual and radiological-feature metrics . This work establishes that foundation models, when appropriately adapted, offer a scalable alternative for interpretable, data-efficient medical image reconstruction. Code is available at https://github.com/ahmetemirdagi/CT-EditMAR.

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.

X-ray computed tomography (CT) suffers from severe metal artifacts when high-attenuation objects such as dental fillings or orthopedic implants are present. These artifacts originate from the polychromatic nature of X-rays, where attenuation varies strongly with photon energy and material composition, breaking the monochromatic assumption used by conventional reconstruction algorithms. Recent neural rendering approaches attempt to address this mismatch through differentiable polychromatic projection models, but they still struggle with smoothness bias, loss of fine structures, and prohibitive computation when extended to large-scale cone-beam CT. We introduce a splat-based metal artifact reduction framework that incorporates a physically grounded polychromatic forward model into a continuous Gaussian representation for cone-beam CT. Each Gaussian encodes the energy-dependent attenuation of the underlying material using a compact material parameterization, which enables efficient joint optimization of geometric and material properties without relying on a metal mask. This compact attenuation formulation captures the essential variation across biological tissues and metallic implants, allowing our model to explain metal-induced nonlinearity while preserving high-frequency structure. Experiments on simulated and real cone-beam CT scans show that our method converges significantly faster and suppresses metal artifacts more effectively than existing reconstruction and neural field-based approaches.