0483: Leprosy - Ultrasound Evaluation of Peripheral Nerves

Introduction

Ultrasound (US) evaluation of peripheral nerves in leprosy is used to assess the severity of the condition, progress of the disease and response to the treatment.

Materials & Methods

16 patients were evaluated from September 2007 to April 2008, had 3 women and 13 men; age range 12–52 years, mean 29.4±10.3 years. The diagnosis of leprosy was based on established clinical, bacteriological and histopathological criteria. A control group of 28 normal individuals were evaluated for comparison.

A total of 58 nerves, including 20 ulnar (UN), 13 median (MN) and 25 posterior tibial (PTN) nerves, were examined. Sequoia, Acuson, and Voluson Expert 730 were used. US image analysis was based on measurement of the maximum cross-sectional area of the nerve, analysis of nerve echo texture, identification of peri-neural tissue and detection of endoneural colour flow signals.

Results

Peripheral nerve was considered normal with size of < 11 sq.mm, echogenic peri-neural tissue, well-defined similar sized fascicles and inter-fascicular epineurium. The characteristic US features were increase in the size of the nerve, peri-neural oedema, decrease/loss of fascicles, increased peri-neural and intra-neural colour flow. Response to treatment was evidenced by decrease in size, normal to echogenic peri-neural tissue, reversal of fascicular pattern and very low colour flow pattern was demonstrated.

Discussion

Ultrasound features are very useful in establishing the diagnosis and following patients after treatment. US evaluation of peripheral nerve involvement is easy, cost-effective and well accepted by the patients.