New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

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

doi:10.1590/s0074-02762013000300001

Cited by 42 publications

(76 citation statements)

References 16 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%

“…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: Introductionmentioning

confidence: 99%

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

et al. 2016

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“…Nerve ultrasound is superior to the clinical examination for identifying nerve enlargement in leprosy . Several nerve ultrasound studies have documented enlargement of multiple nerves and thickening of the epineurium in leprosy patients . Nerve enlargement in leprosy is most common in the ulnar nerve, followed by the median and peroneal nerves .…”

Section: Nerve Sonography In Other Polyneuropathiesmentioning

confidence: 99%

“…Nerve enlargement in leprosy is most common in the ulnar nerve, followed by the median and peroneal nerves . A feature that may be specific to leprosy is pronounced nerve enlargement only a few centimeters proximal to common entrapment sites (e.g., ulnar nerve at the elbow, median nerve at the carpal tunnel) …”

Section: Nerve Sonography In Other Polyneuropathiesmentioning

confidence: 99%

Nerve ultrasound in polyneuropathies

et al. 2018

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Ultrasound can be used to visualize pathology in the peripheral nerves of patients with polyneuropathy. Nerve enlargement is the most frequent pathology, but other abnormalities, including abnormal nerve echogenicity and vascularity, are also encountered. This monograph presents an overview of the role of nerve ultrasound in the evaluation and management of both inherited and acquired polyneuropathies. A description of the sonographic techniques and common abnormalities is provided, followed by a presentation of typical findings in different neuropathies. Scoring systems for characterizing the presence and pattern of nerve abnormalities as they relate to different polyneuropathies are presented. Muscle Nerve 57: 716-728, 2018.

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“…108 The usefulness of POCUS in bacterial infectious diseases has recently been reviewed, describing differentiation between cellulitis and abscesses, diagnosis of septic arthritis, identifying underlying causes of sepsis, and pneumonia. 109 Further US applications have been reported for leprosy, 110,111 rheumatic heart disease as sequelae of Streptococcus pyogenes infection, 112 mycetoma, 105 and opportunistic infections in patients living with HIV. 113,114 With US getting closer to the point of care and into the hands of treating physicians, its use in infectious diseases may increase, and further POCUS indications may become established.…”

Section: Miscellaneous Infectious Diseasesmentioning

confidence: 99%

Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases—A Review of Applications and Perspectives

Bélard¹,

Tamarozzi²,

Bustinduy³

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. The development of good quality and affordable ultrasound machines has led to the establishment and implementation of numerous point-of-care ultrasound (POCUS) protocols in various medical disciplines. POCUS for major infectious diseases endemic in tropical regions has received less attention, despite its likely even more pronounced benefit for populations with limited access to imaging infrastructure. Focused assessment with sonography for HIV-associated TB (FASH) and echinococcosis (FASE) are the only two POCUS protocols for tropical infectious diseases, which have been formally investigated and which have been implemented in routine patient care today. This review collates the available evidence for FASH and FASE, and discusses sonographic experiences reported for urinary and intestinal schistosomiasis, lymphatic filariasis, viral hemorrhagic fevers, amebic liver abscess, and visceral leishmaniasis. Potential POCUS protocols are suggested and technical as well as training aspects in the context of resourcelimited settings are reviewed. Using the focused approach for tropical infectious diseases will make ultrasound diagnosis available to patients who would otherwise have very limited or no access to medical imaging.

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New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

Cited by 42 publications

References 16 publications

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

Nerve ultrasound in polyneuropathies

Point-of-Care Ultrasound Assessment of Tropical Infectious Diseases—A Review of Applications and Perspectives

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