Clinical Metadata Guided Limited-Angle CT Image Reconstruction

Limited-angle computed tomography (LACT) improves temporal resolution and reduces radiation dose, but suffers from severe artifacts due to missing projections. Clinical workflows record abundant patient- and acquisition-level metadata, yet such information remains underutilized in image reconstruction. To tackle the ill-posed LACT inverse problem, we propose a metadata-guided two-stage diffusion framework that leverages structured clinical contexts as semantic priors for robust reconstruction. In Stage-I, we learn a metadata-to-anatomy generative prior by conditioning a transformer-based diffusion model on clinical metadata (acquisition parameters, patient demographics, and diagnostic impressions), and sampling a coarse anatomical estimate from Gaussian noise. In Stage-II, a second conditional diffusion model performs coarse-to-fine refinement, using the Stage-I estimate as an image prior while re-injecting the same metadata to recover full-resolution anatomy. To preserve anatomical fidelity and suppress hallucinations, projection-domain data consistency is enforced periodically after denoising update via an ADMM-based solver. Experiments on the public multimodal CTRATE dataset demonstrate that the proposed framework outperforms iterative, CNN-based, and diffusion-based baselines, with the greatest gains under severe truncation, e.g., up to 5.23%/11.21% higher SSIM/PSNR than the strongest metadata-free diffusion competitor at 90°. On real clinical cardiac CT, it yields coronary artery calcium scores closer to full-view references, indicating improved clinical utility. Furthermore, the proposed method is generalized to out-of-distribution angular ranges and projection geometries, and ablation results confirm complementary contributions from different metadata types under limited-angle conditions. Our results highlight clinical metadata as actionable semantic priors to synergize with physics-informed constraints to improve both reconstruction fidelity and clinical quantification in LACT.