Text-To-Image (TTI) generation is significant for controlled and diverse image generation with broad potential applications. Although current medical TTI methods have made some progress in report-to-Chest-Xray (CXR) generation, their generation performance may be limited due to the intrinsic characteristics of medical data. In this paper, we propose a novel disease-knowledge enhanced Diffusion-based TTI learning framework, named Diff-CXR, for medical report-to-CXR generation. First, to minimize the negative impacts of noisy data on generation, we devise a Latent Noise Filtering Strategy that gradually learns the general patterns of anomalies and removes them in the latent space. Then, an Adaptive Vision-Aware Textual Learning Strategy is designed to learn concise and important report embeddings in a domain-specific Vision-Language Model, providing textual guidance for Chest-Xray generation. Finally, by incorporating the general disease knowledge into the pretrained TTI model via a delicate control adapter, a disease-knowledge enhanced diffusion model is introduced to achieve realistic and precise report-to-CXR generation. Experimentally, our Diff-CXR outperforms previous SOTA medical TTI methods by 33.4\% / 8.0\% and 23.8\% / 56.4\% in the FID and mAUC score on MIMIC-CXR and IU-Xray, with the lowest computational complexity at 29.641 GFLOPs. Downstream experiments on three thorax disease classification benchmarks and one CXR-report generation benchmark demonstrate that Diff-CXR is effective in improving classical CXR analysis methods. Notably, models trained on the combination of 1\% real data and synthetic data can achieve a competitive mAUC score compared to models trained on all data, presenting promising clinical applications.
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