Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements: A systematic review and best-evidence synthesis

Margje B Buitenhuis; Ceren Gürşen; Janine T Hidding; W M Bramer; Remco de Bree; Elise M Gane; Caroline M Speksnijder

doi:10.1016/j.ejrad.2026.113103

Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements: A systematic review and best-evidence synthesis

Margje B Buitenhuis
, Ceren Gürşen
, Janine T Hidding
, W M Bramer
, Remco de Bree
, Elise M Gane
, Caroline M Speksnijder^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

Abstract

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.

Original language	English
Article number	113103
Number of pages	12
Journal	European Journal of Radiology
Volume	204
Early online date	29 Jul 2026
DOIs	https://doi.org/10.1016/j.ejrad.2026.113103
Publication status	E-pub ahead of print - 29 Jul 2026

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Buitenhuis, M. B., Gürşen, C., Hidding, J. T., Bramer, W. M., de Bree, R., Gane, E. M., & Speksnijder, C. M. (2026). Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements: A systematic review and best-evidence synthesis. European Journal of Radiology, 204, Article 113103. Advance online publication. https://doi.org/10.1016/j.ejrad.2026.113103

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title = "Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements: A systematic review and best-evidence synthesis",

abstract = "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.",

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Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements: A systematic review and best-evidence synthesis. / Buitenhuis, Margje B; Gürşen, Ceren; Hidding, Janine T et al.
In: European Journal of Radiology, Vol. 204, 113103, 11.2026.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements

T2 - A systematic review and best-evidence synthesis

AU - Buitenhuis, Margje B

AU - Gürşen, Ceren

AU - Hidding, Janine T

AU - Bramer, W M

AU - de Bree, Remco

AU - Gane, Elise M

AU - Speksnijder, Caroline M

PY - 2026/7/29

Y1 - 2026/7/29

N2 - 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.

AB - 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.

U2 - 10.1016/j.ejrad.2026.113103

DO - 10.1016/j.ejrad.2026.113103

M3 - Review article

C2 - 42541997

SN - 0720-048X

VL - 204

JO - European Journal of Radiology

JF - European Journal of Radiology

M1 - 113103

ER -

Validity, responsiveness, reliability and measurement error of imaging modalities for soft tissue oedema measurements: A systematic review and best-evidence synthesis

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