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原文摘要

Chest X-ray (CXR) interpretation remains challenging because subtle pathology can be obscured by overlapping anatomy, image-quality variation, and limited visual evidence in isolated radiographs. Although image-only deep learning models provide useful baselines, they discard the complementary diagnostic context available in radiology reports, while large vision-language models can be computationally expensive for practical deployment. This paper presents CXR-CMFA, a lightweight cross-modal feature aggregation network for binary CXR pathology classification. The proposed framework combines a dual-stream visual encoder, using EfficientNet-B0 for global anatomical representation and DenseNet-121 for local pathological detail, with a TF-IDF-MLP report encoder. Two fusion modules integrate these modalities: the Dual-Modal Spatial Attention Module (DMSAM) uses the report embedding to gate global and local visual features, and the Cross-Modal Gated Feature Fusion (CGFF) module learns per-instance weights for visual and textual contributions. Experiments on the MIMIC-CXR benchmark, using the provided train, validation, and test splits, show that CXR-CMFA achieves 93.45% accuracy, 99.88% precision, 91.8% recall, 95.7% F1-score, and 99.19% AUC on the held-out test set. The model produces only four false positives among 984 normal test cases, supporting its suitability for high-specificity screening workflows. An ablation study further demonstrates a 22.47 percentage-point AUC improvement over the global-image-only variant, confirming the value of adaptive cross-modal fusion. These results indicate that compact report-conditioned fusion can provide strong discriminative performance without relying on large pretrained language models.