Point-of-care ultrasound of peripheral nerves in the diagnosis of Hansen's disease neuropathy

Glauber Voltan; Fred Bernards Filho; Marcel Nani Leite; Natália Aparecida De Paula; Jaci Maria Santana; Claudia Maria Lincoln Silva; Josafá Gonçalves Barreto; Moises Batista Da Silva; Guilherme Conde; Claudio Guedes Salgado; Marco Andrey Cipriani Frade

doi:10.3389/fmed.2022.985252

Point-of-care ultrasound of peripheral nerves in the diagnosis of Hansen's disease neuropathy

Front Med (Lausanne). 2022 Sep 9:9:985252. doi: 10.3389/fmed.2022.985252. eCollection 2022.

Affiliations

¹ Department of Interne Medicine - Dermatology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
² Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
³ Federal University of Pará, Belém, Pará, Brazil.

Abstract

Introduction: Hansen's disease (HD) is the most common cause of treatable peripheral neuropathy in the world that may or may not involve skin manifestations, and physical examination based on simplified neurologic evaluation is a subjective and inaccurate procedure. High-resolution ultrasound (HRUS) can be used to evaluate peripheral nerves and is a validated technique of good reproducibility, permitting a detailed and precise examination.

Objectives: We proposed to establish objective criteria for absolute values of the measurement of the CSA of peripheral nerves and their indices of the ΔCSA and ΔTpT in the diagnosis of Hansen's disease neuropathy as compared with healthy voluntaries.

Materials and methods: In municipalities from different regions of Brazil, we randomly selected 234 volunteer Brazilian patients diagnosed with leprosy to be submitted to peripheral nerve echography and compared with 49 healthy Brazilian volunteers.

Results: Hansen Disease assessed by high resolution ultrasound is a primarily neural disease that leads to multiple hypertrophic mononeuropathy characterized by CSA values exceeding normal limits (Med CT = 10.2 mm²; UT = 9.8 mm²; UPT = 9.3 mm²; CFFH = 18.3 mm²; T = 9.6 mm²), and the pattern of asymmetry (ΔCSA>2.5 mm² with RR 13) and focality (ΔTPT > 2.5 mm² with RR 6.4) of this thickening has higher sensitivity (76,1%) and specificity (87,8 %) for its early diagnosis that laboratory tests. Analyzing each subject, the percentage of thickened nerves detected among the total number of nerves assessed was higher among patients with HD than among healthy individuals (p < 0.0001). Individuals with two or more thickened nerves were at 24.1 times higher relative risk (95% CI: 6.74-88.98) of HD.

Keywords: Hansen's disease; cross-sectional area; high-resolution ultrasound; leprosy; neuropathy.