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Accurate muscle-mass assessment is crucial for staging and managing sarcopenia, yet existing methods suffer from modality-specific limitations and weak integration of muscle function indicators. To solve these limitations, we propose a Dual-source Features Graph for Sarcopenia Evaluation (DFGSE) to synergize high- and low-energy whole-body Dual-energy X-ray Absorptiometry (DXA) images, local high-energy DXA images, and blood-borne biochemical markers. Specifically, the feature extraction module employs dual-energy feature extraction to disentangle soft-tissue and skeletal cues from low-energy images, while skeleton-aware detection extracts joint features from high-energy images. It yields global and local DXA embeddings, complemented by blood-test representations. In the relevance exploration module, inter- and intra-modality correlations are computed via bilinear transformations to form adjacency matrices for the global, local, and blood modality representations. These matrices seed the Multi-type Multi-relation Graph Convolutional Network (MMGCN) – the core of the relation learning module – which captures both direct and indirect interactions among modalities through relation-aware message passing. Finally, the graph-fused representations are used by a muscle-mass prediction head trained with cross-entropy loss. Experiments on the public MURA dataset and two independent sarcopenia cohorts demonstrate that DFGSE consistently outperforms machine learning and state-of-the-art graph-based methods, in terms of four evaluation metrics for classification task.
