With the rapid development of generative AI in medical imaging, synthetic Computed Tomography (CT) images have demonstrated great potential in applications such as data augmentation and clinical diagnosis, but they also introduce serious security risks. Despite the increasing security concerns, existing studies on CT forgery detection are still limited and fail to adequately address real-world challenges. These limitations are mainly reflected in two aspects: the absence of datasets that can effectively evaluate model generalization to reflect the real-world application requirements, and the reliance on detection methods designed for natural images that are insensitive to CT-specific forgery artifacts. In this view, we propose CTForensics, a comprehensive dataset designed to systematically evaluate the generalization capability of CT forgery detection methods, which includes ten diverse CT generative methods. Moreover, we introduce the Enhanced Spatial-Frequency CT Forgery Detector (ESF-CTFD), an efficient CNN-based neural network that captures forgery cues across the wavelet, spatial, and frequency domains. First, it transforms the input CT image into three scales and extracts features at each scale via the Wavelet-Enhanced Central Stem. Then, starting from the largest-scale features, the Spatial Process Block gradually performs feature fusion with the smaller-scale ones. Finally, the Frequency Process Block learns frequency-domain information for predicting the final results. Experiments demonstrate that ESF-CTFD consistently outperforms existing methods and exhibits superior generalization across different CT generative models.

In AI-generated image detection, current cutting-edge methods typically adapt pre-trained foundation models through partial-parameter fine-tuning. However, these approaches often struggle to generalize to forgeries from unseen generators, as the fine-tuned models capture only limited patterns from training data and fail to reflect the evolving traits of new ones. To overcome this limitation, we propose Image-Adaptive Prompt Learning (IAPL), a novel paradigm that dynamically adjusts the prompts fed into the encoder according to each testing image, rather than fixing them after training. This design significantly enhances robustness and adaptability to diverse forged images. The dynamic prompts integrate conditional information with test-time adaptive tokens through a lightweight learnable scaling factor. The conditional information is produced by a Conditional Information Learner, which leverages CNN-based feature extractors to model both forgery-specific and general conditions. The test-time adaptive tokens are optimized during inference on a single sample by enforcing prediction consistency across multiple views, ensuring that the parameters align with the current image. For the final decision, the optimal input with the highest prediction confidence is selected. Extensive experiments show that IAPL achieves state-of-the-art performance, with mean accuracies of 95.61% and 96.7% on the widely used UniversalFakeDetect and GenImage datasets, respectively. Codes and weights will be released on https://github.com/liyih/IAPL.