CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(04): 514-521
DOI: 10.1055/s-0043-1772466
Systematic Review

The Role of Multimodal Imaging in Differentiating Vasogenic from Infiltrative Edema: A Systematic Review

Alireza Hasanzadeh*
1   Medical School, Tehran University of Medical Sciences, Tehran, Iran
2   Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Hossein Sanjari Moghaddam*
1   Medical School, Tehran University of Medical Sciences, Tehran, Iran
2   Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Madjid Shakiba
2   Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Amir Hossein Jalali
2   Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Kavous Firouznia
2   Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
› Author Affiliations
Funding None.


Background High-grade gliomas (HGGs) are the most prevalent primary malignancy of the central nervous system. The tumor results in vasogenic and infiltrative edema . Exact anatomical differentiation of these edemas is so important for surgical planning. Multimodal imaging could be used to differentiate the edema type.

Purpose The aim of this study was to investigate the role of multimodal imaging in the differentiation of vasogenic edema from infiltrative edema in patients with HGG (grade III and grade IV).

Data Sources A search on PubMed, EMBASE, Scopus, and ISI Web of Science Core Collection up to June 2022 using terms related to (a) multimodal imaging AND (b) HGG AND (c) edema. (PROSPERO registration number: CRD42022336131)

Study Selection Two reviewers screened the articles and independently extracted the data. We included original articles assessing the role of multimodal imaging in differentiating vasogenic from infiltrative edema in patients with HGG. Six high-quality articles remained for the narrative synthesis.

Data Synthesis Dynamic susceptibility contrast imaging showed that relative cerebral blood volume and relative cerebral blood flow were higher in the infiltrative edema component than in the vasogenic edema component. Diffusion tensor imaging revealed a dispute on fractional anisotropy. The apparent diffusion coefficient was comparable between the two edematous components. Magnetic resonance spectroscopy exhibited an increment in choline/creatinine ratio and choline/N-acetyl aspartate ratio in the infiltrative edema component.

Limitations Strict study selection, low sample size of relevant published studies, and heterogeneity in endpoint variables were the major drawbacks.

Conclusions Multimodal imaging, including dynamic susceptibility contrast and magnetic resonance spectroscopy, might help differentiate between vasogenic and infiltrative edema.

Author Contributions

AH was involved in data curation, investigation, drafting, and revision; HSM helped in data curation, investigation, drafting, and revision; MSh contributed to data curation, investigation, supervision, and revision; AHJ helped in conceptualization, methodology, and supervision; KF contributed to conceptualization, supervision, project administration, and revision. All authors read and approved the final manuscript.

Data Availability Statement

This article is a systematic review using previously published articles.

* A.H and H.S.M contributed equally to this study.

Publication History

Article published online:
21 August 2023

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