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Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema
Margje B Buitenhuis1, Ceren Gürşen2, Janine T Hidding3
1Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Objectives:
Effective lymphoedema management depends on early detection and treatment, emphasizing the need for measurement instruments with strong clinimetric properties. This systematic review aimed to identify and evaluate the measurement properties of imaging modalities used to assess soft tissue oedema.
Materials And Methods:
A systematic search of Embase, Medline, Web of Science, and CINAHL (inception-December 2, 2025) identified studies evaluating reliability, validity, and/or responsiveness of imaging modalities capable of visualizing internal tissues that evaluated soft tissue oedema in adults. Methodological quality was assessed using the COSMIN Risk of Bias checklist, and measurement properties were rated according to established criteria. Levels of evidence were synthesized using a best-evidence approach.
Results:
Fifty-nine studies were included, covering six imaging modalities: ultrasound, fluorescence lymphography, magnetic resonance imaging (MRI), lymphoscintigraphy, computed tomography, and dual-energy X-ray absorptiometry. High-quality evidence for sufficient validity was identified exclusively for MRI, particularly in quantifying fluid and soft tissue. High-quality evidence for sufficient reliability was found for MRI in quantifying soft tissue and for fluorescence lymphography when assessing the combination of lymphatic flow and anatomy. Other modalities demonstrated only low- to moderate-level or inconsistent evidence across constructs.
Discussion:
MRI currently provides the most robust and consistent evidence for valid and reliable quantification of soft tissue oedema. Standardization of methodology, broader inclusion of patient populations and body regions, and evaluation of underexplored measurement properties are essential to advance the role of imaging in lymphoedema assessment and management.
Prospero Registration Number:
CRD42024611323.
