Utility of magnetic resonance imaging in the diagnosis of eosinophilic fasciitis: A multicenter retrospective cohort study.

To the Editor: Eosinophilic fasciitis (EF) is a rare sclerosing disorder resulting in edema, erythema, and induration of the extremities due to fascial inflammation and thickening. 1 Shulman L.E. Diffuse fasciitis with hypergammaglobulinemia and eosinophilia: a new syndrome?. J Rheumatol. 1984; 11: 569-570 PubMed Google Scholar Currently, a wedge biopsy is considered the gold standard for diagnosing EF in the appropriate clinical setting. Although there are no official criteria for the diagnosis of EF, the proposed algorithm by Pinal-Fernandez et al includes the major criterion of a full-thickness wedge biopsy demonstrating accumulation of lymphocytes and macrophages with or without eosinophils, whereas T2-weighted magnetic resonance imaging (MRI) with contrast demonstrating hyperintense fascia is considered only a minor criterion. 2 Pinal-Fernandez I. Selva-O’ Callaghan A. Grau J.M. Diagnosis and classification of eosinophilic fasciitis. Autoimmun Rev. 2014; 13: 379-382https://doi.org/10.1016/j.autrev.2014.01.019 Crossref PubMed Scopus (124) Google Scholar Despite this, experts often utilize MRI to diagnose EF given its advantages of being noninvasive, providing information regarding disease extent, circumventing potential for sampling error with biopsy, and allowing for disease progression monitoring. 3 Kubincová M. Vanhoenacker F.M. MRI findings of eosinophilic fasciitis. J Belgian Soc Radiol. 2022; 106: 1-3https://doi.org/10.5334/jbsr.2805 Crossref PubMed Scopus (2) Google Scholar