The recently emerging conditional diffusion models seem promising for mitigating the labor and expenses in building large 3D medical imaging datasets. However, previous studies on 3D CT generation have yet to fully capitalize on semantic and textual conditions, and they have primarily focused on specific organs characterized by a local structure and fixed contrast. In this work, we present GuideGen, a controllable framework that generates anatomical masks and corresponding CT volumes for the entire torso-from chest to pelvis-based on free-form text prompts. Our approach includes three core components: a text-conditional semantic synthesizer for creating realistic full-torso anatomies; a contrast-aware autoencoder for detailed, high-fidelity feature extraction across varying contrast levels; and a latent feature generator that ensures alignment between CT images, anatomical semantics and input prompts. To train and evaluate GuideGen, we compile a multi-modality cancer imaging dataset with paired CT and clinical descriptions from 12 public TCIA datasets and one private real-world dataset. Comprehensive evaluations across generation quality, cross-modality alignment, and data usability on multi-organ and tumor segmentation tasks demonstrate GuideGen's superiority over existing CT generation methods.

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