Evaluation of nerve involvement in Hansen’s disease by a newer technique - high resolution ultra-sonography (HRUS)

Haritha Samanthula, Akshay jain Salecha, Raghuveer Thyagi Pamarthi, Kirthi sampath Kotagiri, Neelakanta Rasineni, Maheswara rao Bommineni


Background  Hansen’s disease is a chronic inflammatory disease caused by Mycobacterium leprae which  primarily  affects skin and peripheral nerves. The presence and degree of nerve involvement is usually evaluated by clinical assessment which has an inherent limitation of being highly subjective and by nerve biopsy which has risk of increasing the neurological deficit. HRUS and Colour Doppler (CD) is shown to be a useful technique to detect nerve damage in leprosy.


Aims and Objective To study the size, echotexture, morphologic alteration and vascularity of peripheral nerves in patients with leprosy by HRUS.


Material and Methods The study was conducted in the departments of Dermatology and Radiology at Dr. PSIMS & RF over a period of 6 months from March 2018 to August 2018. Sample size included 30 clinically diagnosed cases of Hansen’s disease as per Ridley-Jopling classification and these patients were subjected to HRUS and CD to study the nerve involvement.


Results Of the 30 leprosy patients scanned all of them had morphological alterations like increased focal hypoechoic areas, loss of fascicular architecture, thickened epineurium and  3 cases with clinical evidence of reaction showed increased  endoneural vascularity.


Conclusion HRUS is a noninvasive, cost effective tool that gives significant information on nerve structure, morphology and vascularity in the nerve and this adds a new dimension in diagnosing leprosy particularly pure neuritic type and assessment of nerve damage which can prevent disabilities.



Hansen's disease, HRUS, CD

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Jopling WH, McDougall AC. In: Handbook of Leprosy. 5th edition. New Delhi: CBS Publishers, 1996; pp. 1-10.

Khanna N. In: Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases. First edition. Delhi: Peepee Publishers, 2005; pp. 198-209.

Croft RP, Nicholls PG, Steyerberg EW et al. A clinical prediction rule for nerve-function impairment in leprosy patients. Lancet, 2000; 355: 1603-6.

Schuring RP, Richardus JH, Sterberg EW et al. Preventing nerve function impairment in leprosy: validation and updating of a prediction rule. PLoS Negl Trop Dis, 2008; 2: e28. Epub 2008 Aug 27.

Martinoli C, Derchi LE, Bertolotto M et al. US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol 2000; 29: 142-50.

Jain S, Visser LH, Praveen TL et al. High resolution sonography: a new technique to detect nerve damage in leprosy. PLoS Negl Trop Dis 2009; 3: e498.

Fornage BD. Peripheral nerves of the extremities: imaging with US. Radiology. 1988; 167(1): 179-82.

Martinoli C, Derchi LE, Bertolotto M, et al. US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol 2000; 29(3): 142-50.

Elias J Jr, Nogueira-Barbosa MH, Feltrin LT, et al. Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation. J Ultrasound Med 2009; 28(9): 1201-9.

Jain S, Visser LH, Yerasu MR, et al. Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: a case report. Lepr Rev. 2013; 84(2): 161-5.

Cartwright MS, Passmore LV, Yoon JS, et al. Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve 2008; 37(5): 566-71.

Gupta S, Bhatt S, Bhargava SK et al. High resolution sonographic examination: a newer technique to study ulnar nerve neuropathy in leprosy. Lepr Rev 2016; 87: 464-75.

Bathala L, Kumar P, Kumar K, Visser LH. Ultrasonographic cross-sectional area normal values of the ulnar nerve along its course in the arm with electrophysiological correlations in 100 Asian subjects. Muscle & Nerve 2013; 47: 673-76.

Visser LH, Jain S, Lokesh B, Suneetha S, Subbanna J. Morphological changes of the epineurium in leprosy: A new fi nding detected by high-resolution sonography. Muscle Nerve 2012; 46: 38-41.

Jain S, Visser LH, Yerasu MR, Raju R, Meena AK, Lokesh B, et al. Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: A case report. Lepr Rev 2013; 84: 161-5.

Slim FJ, Faber WR, Maas M. The role of radiology in nerve function impairment and its musculoskeletal complications in leprosy. Lepr Rev 2009; 80: 373-87.

Goedee HS, Brekelmans GJF, van Asseldonk JTH, et al. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy-a review of the literature. Eur J Neurol 2013; 20(10): 1342-51.


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