{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:25:14Z","timestamp":1789079114490,"version":"build-2803163510"},"reference-count":63,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science Foundation","award":["2234468"],"award-info":[{"award-number":["2234468"]}]},{"name":"National Science Foundation","award":["2234836"],"award-info":[{"award-number":["2234836"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["U01CA200464"],"award-info":[{"award-number":["U01CA200464"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"name":"James and Esther King Foundation","award":["8JK02"],"award-info":[{"award-number":["8JK02"]}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"crossref","award":["PA210192"],"award-info":[{"award-number":["PA210192"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Loss of skeletal muscle mass in cancer cachexia is associated with poorer survival, reduced treatment tolerance, and diminished quality of life. Routine oncology computed tomography (CT) can yield skeletal muscle area (SMA) and skeletal muscle index (SMI) for early cachexia assessment and prognostication, but manual annotation is labor intensive and existing automated tools often show inconsistent reliability. We developed SMAART-AI (Skeletal Muscle Assessment\u2014Automated and Reliable Tool based on AI), a fully automated pipeline that localizes the third lumbar (L3) vertebral level, segments skeletal muscle, and quantifies prediction uncertainty to flag potentially unreliable outputs. Performance and reliability were evaluated across gastroesophageal, pancreatic, colorectal, and ovarian cancer cohorts, benchmarking against expert annotations and existing tools. SMAART-AI achieved a Dice score of 97.80% \u00b1 0.93% in gastroesophageal cancer and a median SMA deviation of 2.48% from expert annotations across pancreatic, colorectal, and ovarian cohorts. Uncertainty scores correlated strongly with prediction error, enabling identification of high-error cases to support trustworthy deployment. Integrating the SMA\/SMI with clinical features and body mass index (BMI) improved survival prediction (concordance index was +2.19% for colorectal, +9.82% for pancreatic, and +2.58% for ovarian cancer) and supported cachexia detection (70.00% accuracy; F1 80.00%). Overall, SMAART-AI provides an uncertainty-aware, clinically translatable framework for scalable CT-based muscle assessment and improved oncologic prognostication.<\/jats:p>","DOI":"10.3390\/cells15060515","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:06:22Z","timestamp":1773414382000},"page":"515","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reliable Radiologic Skeletal Muscle Area Assessment\u2014A Biomarker for Cancer Cachexia Diagnosis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0456-3073","authenticated-orcid":false,"given":"Sabeen","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"},{"name":"Department of Electrical Engineering, University of South Florida, Tampa, FL 33620, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8947-7942","authenticated-orcid":false,"given":"Nathan","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Park","sequence":"additional","affiliation":[{"name":"Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"},{"name":"Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Jeong","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6620-8600","authenticated-orcid":false,"given":"Lauren C.","family":"Peres","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5430-3934","authenticated-orcid":false,"given":"Evan W.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"},{"name":"Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4726-9264","authenticated-orcid":false,"given":"Jennifer B.","family":"Permuth","sequence":"additional","affiliation":[{"name":"Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"},{"name":"Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1779-2510","authenticated-orcid":false,"given":"Erin M.","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3241-3216","authenticated-orcid":false,"given":"Matthew B.","family":"Schabath","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2014-3060","authenticated-orcid":false,"given":"Yasin","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering, University of South Florida, Tampa, FL 33620, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8551-0090","authenticated-orcid":false,"given":"Ghulam","family":"Rasool","sequence":"additional","affiliation":[{"name":"Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA"},{"name":"Department of Electrical Engineering, University of South Florida, Tampa, FL 33620, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Park, M.A., Whelan, C.J., Ahmed, S., Boeringer, T., Brown, J., Carson, T.L., Crowder, S.L., Gage, K., Gregg, C., and Jeong, D.K. (2024). Defining and Addressing Research Priorities in Cancer Cachexia through Transdisciplinary Collaboration. 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