Role of High-resolution Ultrasonography in the Evaluation of Ulnar Nerve Involvement in Patients with Leprosy.

BackgroundLeprosy is an age-old chronic infectious disease with the majority of annual new case detections from South-East Asia. The disease manifestations coupled with the stigma attached to it often creates grave socioeconomic problems. Leprosy is curable and if detected and treated in the early stages can prevent disability. Ultrasonography provides information regarding location and degree of the nerve damage, nerve morphologic alterations, echo texture, fascicular pattern and vascularity. The aim of this study was to study the ultrasonographic features of neuropathy in leprosy with electrophysiologic correlation.ResultsA total of 34 histopathological proven cases of leprosy were included in this study, which was conducted for 1 year. High-resolution ultrasound (HRUS) of a total of 204 peripheral nerves in these 34 patients, including bilateral ulnar, median and common peroneal nerves, was performed. Cross-sectional areas, nerve diameters, nerve morphology and vascularity were noted and correlated with electrophysiologic study of these nerves. The results showed that all the patients having reduced motor or sensory function [decreased compound muscle action potential (CMAP), decreased compound nerve action potential (SNAP) and increased latency] in ulnar and common peroneal nerves were thickened on HRUS (100% in ulnar and common peroneal nerves) while 92% right median and 89% left median nerves with reduced motor or sensory function showed thickening on HRUS. Also, 5.8% ulnar nerves and 11.7% common peroneal nerves showed thickening on HRUS; however, sensory or motor conduction of these nerves was unaffected on nerve conduction study (NCS). So, a positive correlation was observed for nerve involvement as detected by ultrasonographic findings of nerve hypertrophy and the electrophysiologic study. The most common finding was focal or diffuse nerve thickening. Ulnar nerve was the most commonly thickened nerve in leprosy patients with the most common location of nerve thickening at medial epicondyle.ConclusionsUltrasound and electrophysiologic study of peripheral nerves in leprosy are complimentary to each other in diagnosing leprotic neuropathy.

The impact of hand dominance and ulnar and median nerve impairment on strength and basic daily activities

Background: Ultrasonography is a safe and cost-effective modality to assess gross morphological changes in nerves non-invasively. Early diagnosis will allow the early institution of therapy and arrest the progression of the disease thus, helping in decreasing disabilitygrading. Aims and Objectives: The aim of the study was to assessing the role of high resolution ultrasonography (HRUS) in leprosy. The objectives of the study were to detect sonographic changes in nerves in leprosy patients, and to detect neural complications by sonography in leprosy patients. Materials and Methods: The study was conducted over 18 months from the year 2020–2021 at ‘Teerthanker Mahaveer Medical College and Research Centre, Moradabad. A total of 37 patients were included in our study. HRUS was performed on the bilateral ulnar nerve (UN), median nerve (MN), radial nerve (RN), lateral popliteal (LPN) nerve, and posterior tibial nerve (PTN) to see the following parameters: Nerve thickening, echogenicity, color flow, and abscess. Results: The UN was most frequently involved followed by the PTN, MN, LPN, and RN. Diagnostic performance of HRUS for echogenicity was good with sensitivity, positive predictive value, and accuracy and was observed as 91.17%, 100%, and 91.17%, respectively. Conclusion: HRUS has several benefits in leprosy scanning; it is a reliable and non-invasive method of assessing alternations in the nerve at sites that may be difficult to be biopsied for histology.

Early detection of peripheral neuropathy is extremely important as leprosy is one of the treatable causes of peripheral neuropathy. The study was undertaken to assess the role of diffusion tensor imaging (DTI) in ulnar neuropathy in leprosy patients. This was a case-control study including 38 patients (72 nerves) and 5 controls (10 nerves) done between January 2017 and June 2019. Skin biopsy proven cases of leprosy, having symptoms of ulnar neuropathy (proven on nerve conduction study) were included. MRI was performed on a 3 T MR system. Mean cross-sectional area, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of ulnar nerve at cubital tunnel were calculated. Additional ancillary findings and appearance of base sequences were evaluated. Ulnar nerve showed thickening with altered T2W signal in all the affected nerves, having an average cross-sectional area of 0.26 cm2. Low FA with mean of 0.397 ± 0.19 and high ADC with mean of 1.28 ± 0.427 x 10 -3 mm2/s of ulnar nerve in retrocondylar groove was obtained. In the control group, mean cross-sectional area was 0.71cm2 with mean FA and ADC of 0.53 ± 0.088 and 1.03 ± 0.24 x 10 -3 mm2/s respectively. Statistically no significant difference was seen in diseased and control group. Cut-off to detect neuropathy for FA and ADC is 0.4835 and 1.1020 × 10 -3 mm2/s respectively. DTI though is challenging in peripheral nerves, however, is proving to be a powerful complementary tool for assessment of peripheral neuropathy. Our study validates its utility in infective neuropathies. 1. DTI is a potential complementary tool for detection of peripheral neuropathies and can be incorporated in standard MR neurography protocol.2. In leprosy-related ulnar neuropathy, altered signal intensity with thickening or abscess of the nerve is appreciated along with locoregional nodes and secondary denervation changes along with reduction of FA and rise in ADC value.3. Best cut-offs obtained in our study for FA and ADC are 0.4835 and 1.1020 × 10 -3 mm2/s respectively.

Context:Assessment of peripheral nerves in leprosy by clinical methods is subject to considerable inter-observer variability. High resolution ultrasonography (HRUS) can assess peripheral nerves more objectively.Aims:To compare the findings of peripheral nerve involvement in newly diagnosed cases of leprosy by clinical and sonological methods.Settings and Design:Cross sectional study in a tertiary care teaching hospital.Subjects and Methods:Four pairs of peripheral nerves of 40 newly diagnosed patients with leprosy were examined clinically and by HRUS.Statistical Analysis Used:Agreement between clinical examination and HRUS using kappa statistic; sensitivity; specificity; and predictive values.Results:Of the 320 nerves examined, 71 (22.18%) were abnormal clinically and 63 (19.7%) sonologically. Sonological abnormalities were increased cross sectional area (n = 63; 100%), hypoechogenicity with loss of fascicular architecture (n = 46; 73%) and increased vascularity (n = 35; 55.6%). There was moderate agreement (Cohen's Ḳ = 0.59) between clinical and sonological findings. HRUS findings were abnormal in 18 (7.2%) nerves that were clinically normal. HRUS was normal in 26 (36.6%) nerves which were clinically abnormal. Sensitivity of HRUS compared to clinical examination was 63%; specificity 92.7%; positive predictive value 71.4%; and negative predictive value 89.9%. Increased cross sectional area agreed with clinical findings the most.Conclusions:HRUS has low sensitivity (63%) and high specificity (92.7%) to identify abnormal peripheral nerves in leprosy, compared to clinical examination. It could detect abnormality of some (n = 18, 7.2%) clinically normal nerves, but showed normal findings of some nerves (n = 26, 36.6%), which were considered clinically abnormal.

Leprosy is a chronic granulomatous disease that commonly affects the peripheral nervous system, often leading to significant disability. High-resolution ultrasonography has emerged as a promising tool for the noninvasive assessment of nerve involvement in leprosy. To figure out the diagnostic value of HRUS in assessing peripheral nerve involvement in leprosy, with a focus on measuring the cross-sectional area (CSA) of major nerves. A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted up to 2024. Seventeen studies were included, and quality assessment was performed using NIH and NOS tools. Meta-analyses compared CSA of the ulnar, median, posterior tibial, and common fibular nerves between patients with leprosy and healthy controls. Heterogeneity was evaluated using the I2 statistic and sensitivity analyses were performed. Patients with leprosy showed significantly increased CSA in all examined nerves compared with controls. Single-arm analysis of CSA in patients with leprosy showed consistent nerve enlargement, particularly in the ulnar nerve. Our review shows the usefulness of HRUS as a sensitive, noninvasive imaging modality for evaluating peripheral nerve involvement in leprosy.

Involvement of the ulnar nerve in patients with carpal tunnel syndrome is controversial. The aim of our study was to evaluate sonographic findings in the ulnar nerve in patients with carpal tunnel syndrome. We performed median and ulnar nerve conduction studies with sonography in 109 hands of 60 patients with clinically suspected carpal tunnel syndrome. Sonographic findings were analyzed with regard to electrophysiologic stages of carpal tunnel syndrome. We found that the sensory conduction velocity of the ulnar nerve decreased as the electrophysiologic stage of carpal tunnel syndrome increased (P = .038), but there was no change in the cross-sectional area of the ulnar nerve at the wrist. The median-to-ulnar nerve cross-sectional area ratio at the wrist showed a significant correlation with the electrophysiologic stage of carpal tunnel syndrome (Spearman r = 0.431; P < .0001), in addition to the median nerve cross-sectional area at the wrist and the wrist-to- forearm median nerve cross-sectional area ratio. In our study, ulnar nerve involvement in patients with carpal tunnel syndrome was shown electrophysiologically but not sonographically. These results suggest that morphologic changes in the ulnar nerve do not occur in carpal tunnel syndrome, although functional changes may occur.

Role of high resolution ultrasonography in diagnosing septic hip arthritis in premature neonates admitted to the neonatal intensive care unit

Peripheral nerve involvement is a well-established feature of leprosy. However, it may go unnoticed by clinicians due to a decline in clinical examination skills. High-resolution ultrasonography (HRUS) offers the advantage of identifying subclinical nerve involvement at an earlier stage.This article aims to evaluate and compare the effectiveness of HRUS and clinical examination in detecting peripheral nerve involvement in leprosy, the correlation of sonological findings with clinical findings, and the calculation of sensitivity, specificity, and predictive values of HRUS taking clinical examination as the reference method.This cross-sectional observational study was conducted over 1.5 years involving 60 newly diagnosed leprosy patients. Clinical assessment and sonographic evaluation of five nerve pairs (ulnar, median, greater auricular, common peroneal, and posterior tibial) were done. Findings were recorded, analyzed, and compared.HRUS detected abnormalities in 111 of 600 (18.5%) of all nerves, surpassing the 90 of 600 (15%) nerves detected clinically. HRUS parameters demonstrated substantial agreement with clinical findings, with Cohen's kappa values of 0.740 for cross-sectional area, 0.246 for hypervascularity, and 0.166 for hypoechogenicity. The overall diagnostic performance of HRUS reported a sensitivity of 86.7%, specificity of 93.5%, and positive predictive value of 70.3% with a negative predictive value of 97.6%.This study highlights the critical role of HRUS in detecting and monitoring leprosy neuropathy, emphasizing its superiority over clinical examination in identifying both early and advanced nerve involvement.

Objectives:The purpose of the study was to evaluate the role of high resolution ultrasonography to differentiate between benign and malignant cervical lymph nodes in oral squamous cell carcinoma.Materials &amp; Methods:The study was conducted in the Department of Oral and Maxillofacial Surgery, BSMMU,Dhaka, Bangladesh, during a period of January -2010 to December - 2011. A total number of 41 patients with clinical evidence of palpable cervical lymph nodes in oral squamous cell carcinoma were evaluated with high resolution ultrasonography. To evaluate the diagnostic accuracy of high resolutionultrasonography, the high resolution ultrasonography findings were compared and correlat- ed with histopathological examination after neck dissection.Results: All patients were pre-operatively examined by palpation and high resolution ultrasonography evaluation was done.Among them 41 study subjects, on high resolution ultrasonography evaluation 23(56.09%) lymph nodes were metastatic and 18(43.90%) lymph nodes were reactive. After postop- erative excisional histopathology examination 22(53.66%) lymph nodes were metastatic and 19(46.34%) lymph nodes were reactive in nature. Correlation of vascular flow pattern with histopatho- logical diagnosis showed that central flow for benign nodes, mixed &amp; peripheral flow for malignant nodes were highly significant parameters (P&lt;0.001). High resolution ultrasonography has specificity 78.94%, sensitivity 86.36% and diagnostic accuracy of the high resolution ultrasonography was 82.92%.Conclusion: High resolution ultrasonography can plays a definite role as an adjunct to the clinical evaluation of palpable cervical lymph nodes and proves its value as an important noninvasive investi- gation procedure for differentiating between benign and malignant cervical lymph nodes in oral squa- mous cell carcinoma.Update Dent. Coll. j: 2017; 7 (2): 19-27

Contribution of static and dynamic ultrasound in cubital tunnel syndrome

Objectives To explore the utility of high-resolution ultrasonography (HRUS) in leprosy by assessing changes in peripheral nerves. Methods This study follows the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). Relevant studies up to 1 July 2024 were systematically searched using three databases, and the quality of the included studies was further assessed using the Newcastle-Ottawa Scale. Results The results consistently indicated that leprosy patients exhibited significant nerve thickening across various nerves, particularly the ulnar, median, and peroneal nerves with high sensitivity and specificity. Notably, HRUS also demonstrated its ability to detect subclinical nerve involvement in leprosy patients’ household contacts (HHC), suggesting its potential utility in early screening efforts. Conclusion HRUS emerges as a promising diagnostic tool for leprosy, offering enhanced objectivity and superior sensitivity and specificity compared to current diagnostic tools by detecting nerve involvement. This method is effective not only in diagnosing symptomatic patients but also in identifying nerve abnormalities in HHC and individuals without visible skin manifestations.

Objective:High-resolution ultrasonography (HRUS) has been used recently to characterize median and ulnar nerves but is seldom used to characterize the lower extremity nerves. The reference standard for normal the lower extremity nerves has not been established. Thus, this study measured the cross-sectional areas (CSAs) of the sciatic nerve of 200 healthy male or female volunteers, aged 18–80 using HRUS. These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evaluation of peripheral neuropathies.Methods:Two hundred healthy volunteers with 400 lower extremities were studied with HRUS. According to their age, the subjects were assigned to young group (18-30 years, n = 75), middle group. (31-60 years, n = 70), and old group(61-80 year, n = 55). Age, sex, height, weight were recorded and CSAs of sciatic nerve were obtained at every predetermined sites.Results:The mean CSAs of sciatic nerves at GS and MGPF were 0.527 ± 0.028 cm2 and 0.444 ± 0.026 cm2 respectively. Pearson's correlation analysis showed that the mean CSAs were correlated with height and weight. There was no difference in mean CSAs among the three groups (P > 0.05). Women had smaller CSAs of the normal Sciatic nerves than men in two measuring sites (GS, MGPF) (P < 0.05).Conclusion:Peripheral nerve ultrasonography is a reliable and reproducible diagnostic method in the hands of experienced examiners. Normal values for the sciatic nerve nerves are provided by our study. Thus, reference values of Sciatic nerve CSA of the lower extremity can facilitate the analysis of abnormal nerve conditions.

To determine ultrasonographic peripheral nerve involvement in patients with asymptomatic neurofibromatosis type 1 (NF1). Thirteen asymptomatic and 4 minimally symptomatic patients with NF1 were included in this cross-sectional pilot study to detect asymptomatic abnormalities of the brachial plexus and upper and lower extremity nerves. Patients underwent clinical examination, nerve conduction studies (NCS), and high-resolution ultrasonography (HRUS). HRUS showed abnormalities in 16 patients (94.1%). Neurofibromas were identified in 10 patients (58.8%): localized neurofibromas were found in 3 patients (17.6%), plexiform neurofibromas in 3 (17.6%), and both in 4 (23.5%). In 6 patients (35.3%), only nerve enlargement without an abnormal fascicular pattern was observed. Severe involvement of the peripheral nervous system with multiple plexiform neurofibromas was observed in 7 patients (41.2%), while 4 patients (23.5%) had no or only minor involvement. Both NCS and HRUS were performed on 73 individual nerve segments. In 5.5%, abnormalities were found with both tests; in 50.7%, only with HRUS; and in 1.4%, only with NCS. HRUS frequently showed subclinical involvement of the peripheral nerves in NF1, also when NCS were normal. HRUS findings ranged from normal to widespread peripheral nerve involvement. Because the presence of plexiform neurofibromas and the benign tumor load are risk factors for the development of a malignant peripheral nerve sheath tumor, HRUS may be a useful tool to identify a subgroup of patients who could benefit from regular follow-up.

Traditionally, peripheral nerve lesions are diagnosed on the basis of clinical history, physical examination, and electrophysiological studies, and the role of imaging studies has been limited. The purpose of the study was to assess the usefulness of sonography in diagnosing peripheral nerve lesions. Thirty adult patients with peripheral nerve lesion/s and 30 healthy adult volunteers were included in the study, and sonography of the relevant peripheral nerve/s was done. The mean cross-sectional area (CSA) of the involved nerves were compared using Student t-test. The study included patients with diabetic peripheral neuropathy (DPN), carpal tunnel syndrome, leprosy, peripheral nerve tumor, and peripheral nerve trauma. There was a significant increase in CSA of the median nerve and ulnar nerve in DPN patients, and of the median nerve within the carpal tunnel in carpal tunnel syndrome (P < 0.0001) as compared to age and sex-matched controls. Sonography showed significant thickening of both the ulnar and median nerves in patients with leprosy. On sonography, schwannoma and neurofibroma had a similar appearance and showed internal vascularity. In case of neural trauma, sonography allowed precise localization of the site and type of nerve injury. High-resolution sonography is useful in characterizing peripheral nerve lesions and can complement other diagnostic investigations such as the nerve conduction study. It is easily available and has the potential to become the first modality for the evaluation of focal peripheral nerve disorders.