US and MR imaging of peripheral nerves in leprosy

Abstract

US and MR imaging are able to detect nerves abnormalities in leprosy. Active reversal reactions are indicated by endoneural color flow signals as well as by an increased T2 signal and Gd enhancement. These signs would suggest rapid progression of nerve damage and a poor prognosis unless antireactional treatment is started.

New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

“…Considering the polymorphic aspect of leprosy neuropathy, diagnosis may be difficult even in countries with high incidence rates. Clinical findings, electrophysiological tests and nerve sonographic characteristics of leprosy neuropathy have been described previously (Grimaud et al 2000, Martinoli et al 2000, Marques et al 2003, Arruda et al 2004, Elias Jr et al 2009, Bathala et al 2012.…”

“…US and MRI are effective in diagnosing nerve dam-MRI are effective in diagnosing nerve damare effective in diagnosing nerve damage in leprosy, primarily during leprosy reactions (Martinoli et al 2000, Jain et al 2009). In our study, US was performed at the time of leprosy diagnosis and 17 patients (22%) presented with neuritis and/or clinical signs of reversal reactions, which were not always associated with US abnormalities.…”

“…In our study, US was performed at the time of leprosy diagnosis and 17 patients (22%) presented with neuritis and/or clinical signs of reversal reactions, which were not always associated with US abnormalities. Martinoli et al (2000) examined the injured M, ulnar and posterior tibial nerves in 23 LPs (58 nerves) with sonography and MRI. Based on the sonographic or MRI appearance, a nerve could be classified as normal (group I), enlarged with fascicular abnormalities (group II) or having no fascicular structure (group III).…”

“…Recently, sonography has been described as a useful tool in the diagnosis of leprosy neuropathy. 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.…”

Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

“…19 In addition to perineurioma, the differential diagnosis of nerve thickening, increased T2 signal, and contrast enhancement on MRI studies is broad and includes neoplastic entities such as nerve sheath tumors and lymphoma, inherited diseases, infectious entities such as leprosy, and inflammatory processes such as inflammatory pseudotumor of nerve. 4,5,18,36 In our experience, the T2 signal change and enhancement in our case were more intense than typically seen in perineuriomas and more closely mimicked the T2 signal of a nerve sheath tumor. It is important to note both that the MRI appearance of lepromatous nerves can vary depending on the severity of the neuritis and that the resolution of changes may cor- respond with successful treatment, so that a lack of enhancement does not preclude the diagnosis of leprosy.…”