Abstract
To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy.
Highlights
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae that predominantly affects the skin and peripheral nerves (Britton & Lockwood 2004, Lasry-Levy et al 2011)
A highly correlated finding is a fusiform thickening of the peripheral nerves that are generally compromised in leprosy patients (LPs), including the ulnar, median (M) and posterior tibial nerves, which can be measured by the corresponding cross-sectional areas (CSAs) of the affected regions (Martinoli et al 2000, Elias Jr et al 2009)
Leprosy neuropathy is responsible for many of the feared consequences of an M. leprae infection, which may progress to severe impairment followed by disabilities and deformities if diagnosis and treatment are delayed
Summary
The means of the ulnar, M and CF CSA measurements in the HVs were lower than those in the LPs (p < 0.0001). The distributions of the measurements of each studied nerve are shown in Figs 1, 2. Among the HVs, the CSAs of the right M and CF nerves were greater than those of the left-sided nerves (p < 0.005 and p < 0.0016, respectively) (Fig. 2A, B). No other significant difference was found between the two sides
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