Asymmetric Nerve Enlargement: A Characteristic of Leprosy Neuropathy Demonstrated by Ultrasonography

Lugão, Helena Barbosa; Nogueira-Barbosa, Marcello Henrique; Marques, Wilson; Foss, Norma Tiraboschi; Frade, Marco Andrey Cipriani

doi:10.1371/journal.pntd.0004276

Cited by 31 publications

(46 citation statements)

References 14 publications

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“…We expected to detect higher odds for poor outcomes in the MB and in the patients with reactions, but we observed increments in the OR only for the right median nerve CSA in patients with reactions; the other analyses of the OR (CSA, echogenicity, and Doppler) revealed similar odds between PB and MB and between patients with and without reactions. These results are very important because there are few studies that have investigated imaging findings in leprosy neuropathy, and all of them were transversal studies [8–10,12,15,16,28]. …”

Section: Discussionmentioning

confidence: 99%

“…One hundred patients underwent bilateral high-resolution US of the peripheral nerves before starting the World Health Organization (WHO) MDT. The pre-treatment results have been published [15]. Seventy-three leprosy patients repeated US after completion of MDT (31 women and 42 men, age range 8–86 years, age mean 45.3±17.3).…”

Section: Methodsmentioning

confidence: 99%

“…The US exam was performed as previously described [15]. Musculoskeletal radiologists with previous fellowship training in nerve imaging performed all US sessions using a 12-MHz linear transducer model HDI-11 (Philips Medical Systems, Bothell, Washington, USA).…”

Section: Methodsmentioning

confidence: 99%

“…One study that evaluated the reliability of nerve palpation detected poor agreement between trained staff [7]. Recently, ultrasonography (US) has been used to document anatomical nerve abnormalities in patients with leprosy [8–15]. US provides objective measurements of nerve enlargement and asymmetry [12,15] and can identify more extensive involvement than clinical examination [9].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, ultrasonography (US) has been used to document anatomical nerve abnormalities in patients with leprosy [8–15]. US provides objective measurements of nerve enlargement and asymmetry [12,15] and can identify more extensive involvement than clinical examination [9]. Additionally, leprosy patients can have nerve enlargement detected with US without functional impairment identified in neurophysiological studies and vice versa [10,16].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

et al. 2016

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BackgroundPrevious studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT.Methodology/Principal findingsWe performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p<0.05). Despite this reduction, we observed a greater frequency of poor CSA outcomes in the MB compared to the PB (77.8% and 40.6%; p>0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; p<0.05). There was significantly higher odds ratio (7.75; 95%CI: 1.56–38.45) for poor CSA outcomes only for M nerve in patients with reactions. Poor echogenicity outcomes were more frequent in MB (59.4%) compared to PB (22.2%) (p<0.05). There was significant association between poor Doppler outcomes and neuritis. Gender, disease duration, and leprosy classification were not significant risk factors for poor outcomes in CSA, echogenicity or Doppler.Conclusions/SignificanceUS nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

et al. 2016

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Neuromuscular ultrasound in leprosy: A scanning protocol

Pirola,

Visser,

Nasr‐Eldin

et al. 2023

J of Clinical Ultrasound

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The diagnosis of leprosy neuropathies has been traditionally based on clinical findings and electrodiagnostic studies, but ultrasound has emerged as a new tool for use in clinical practice. We conducted a literature search on the subject and developed a pragmatic ultrasound scanning protocol for patients with confirmed or suspected leprosy neuropathy. We suggest scanning the ulnar, median, superficial radial, common fibular and sural nerves at specific sites and assessing cross‐sectional area, vascularity, and epineural thickness. Our protocol is potentially useful in differentiating leprosy neuropathies from other demyelinating neuropathies, but its applicability and accuracy must be evaluated in different centers.

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Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy

Nasr‐Eldin,

Cartwright,

Hamed

et al. 2023

J of Ultrasound Medicine

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ObjectivesTo explore neurofilament light chain (NfL) levels in leprotic neuropathy compared to controls, and to determine if the changes correlate with ultrasonographic nerve findings.MethodsIndividuals with leprosy with signs or symptoms suggestive of peripheral nerve involvement were recruited. They were evaluated by clinical examination, functional scores, laboratory assessments (including NfL), nerve conduction studies (NCS), and ultrasound. Ultrasound was conducted in bilateral median, ulnar, tibial, fibular, sural, and vagus nerves as well as cervical roots 5 and 6. Results were compared to age, sex, and body mass index matched healthy controls.ResultsA total of 320 nerves from 20 patients and 480 nerves from 30 controls were evaluated. NfL was significantly elevated in those with leprosy with a mean and standard deviation of 7.50 + 2.83 compared with 3.42 + 1.18 in controls (P < .001). Ultrasound showed focal enlargement of the nerves, particularly at entrapment sites. Additionally, there were noticeable changes in neural Doppler signal, echogenicity, and epineural thickness among the measured nerve sites. NfL levels in those with leprosy correlated closely with nerve cross‐sectional area at all sites (P < .05). Functional and clinical assessment scores correlated with NfL and sonographic cross‐sectional area as well (P ≤ .05).ConclusionsNfL is elevated in leprotic neuropathy. Ultrasound showed specific morphological changes in individuals with leprosy, and nerve enlargement correlated with NfL levels. Thus, both modalities may be useful for the diagnosis, prognosis, and disease monitoring in those with leprotic neuropathy, and further investigations are warranted.

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Asymmetric Nerve Enlargement: A Characteristic of Leprosy Neuropathy Demonstrated by Ultrasonography

Cited by 31 publications

References 14 publications

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

Neuromuscular ultrasound in leprosy: A scanning protocol

Exploration of Neurofilament Light Chain and Nerve Ultrasound in Leprotic Neuropathy

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