ProSAC-CT: Progressive Spectral-Anatomical Co-Guided Multi-Stage Diffusion Model for Low-Dose CT Denoising

Low-dose computed tomography (CT) denoising is crucial for reduced radiation exposure while ensuring diagnostically acceptable image quality. Despite significant advancements driven by deep learning (DL) in recent years, existing DL-based methods, typically trained on a specific dose level and anatomical region, struggle to handle diverse noise characteristics and anatomical heterogeneity during varied scanning conditions, limiting their generalizability and robustness in clinical scenarios. In this paper, we propose FoundDiff, a foundational diffusion model for unified and generalizable LDCT denoising across various dose levels and anatomical regions. FoundDiff employs a two-stage strategy: (i) dose-anatomy perception and (ii) adaptive denoising. First, we develop a dose- and anatomy-aware contrastive language-image pre-training model (DA-CLIP) to achieve robust dose and anatomy perception by leveraging specialized contrastive learning strategies to learn continuous representations that quantify ordinal dose variations and identify salient anatomical regions. Second, we design a dose- and anatomy-aware diffusion model (DA-Diff) to perform adaptive and generalizable denoising by synergistically integrating the learned dose and anatomy embeddings from DA-CLIP into diffusion process via a novel dose and anatomy conditional block (DACB) based on Mamba. Extensive experiments on a large simulated multi-dose CT dataset spanning three anatomical regions, together with cross-dataset evaluations on Mayo-2016, CQ500, and piglet datasets, demonstrate superior denoising performance and strong generalization to unseen dose levels and anatomical regions. The codes and models are available at https: //github.com/hao1635/FoundDiff.

Computed tomography (CT) plays a crucial role in medical diagnosis, but minimizing radiation exposure while maintaining image quality remains a critical challenge. Low-dose CT (LDCT) protocols reduce radiation risks but inevitably suffer from severe noise and artifacts that compromise diagnostic accuracy. While existing deep learning methods have achieved promising results, there remains a continuous quest for generative paradigms that intrinsically capture global-to-local structural dependencies to better preserve fine anatomical details. To this end, we propose DeVAR, a novel generative framework that applies visual autoregressive modeling (VAR) to LDCT denoising for the first time. Conditioned on global context provided by LDCT prefix tokens, DeVAR progressively generates discrete token maps of the target normal-dose CT (NDCT) via next-scale prediction. Because quantization inherently discards high-frequency information, we introduce a residual refiner to capture subtle anatomical structures beyond the capacity of a discrete codebook. Finally, empowered by a dual-representation hybrid training strategy, our hybrid NDCT decoder seamlessly integrates continuous and discrete latents to reconstruct high-fidelity, detail-preserved images. Extensive experiments on two public datasets demonstrate that DeVAR consistently achieves superior qualitative and quantitative performance compared to state-of-the-art LDCT denoising methods.

Computed tomography (CT) is a critical imaging modality for clinical diagnosis, but reducing radiation dose inevitably introduces severe noise and structured artifacts that degrade image quality. Existing deep learning-based low-dose CT (LDCT) reconstruction methods are typically optimized for fixed dose levels or specific anatomical regions, limiting their robustness and generalization in realistic clinical settings. We propose GenDiff, a generalizable diffusion-based framework for LDCT reconstruction that jointly models continuous radiation dose and anatomical information within a unified reconstruction network. The proposed framework integrates a Dose-Anatomy Encoder to learn acquisition-aware embeddings, a dose- and anatomy-conditioned cold diffusion backbone for iterative refinement, a physics-consistency update to enforce fidelity to the CT forward model, and a Structural Prior Refinement Module (SPRM) that preserves anatomical structures while suppressing dose-dependent artifacts. Extensive experiments on multi-anatomy clinical datasets, including unseen ultra-low-dose conditions as well as out-of-distribution phantom and animal datasets, demonstrate that GenDiff consistently outperforms state-of-the-art convolutional neural network and diffusion-based reconstruction methods. The proposed approach achieves superior reconstruction quality while maintaining strong robustness across different dose levels, anatomical regions, and acquisition domains, making it a promising solution for practical low-dose CT imaging.