title: Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the diagnostic usefulness of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation.
  
  
  METHODS
  Twenty-one consecutive patients with leprosy (12 men and 9 women; mean age +/- SD, 47.7 +/- 17.2 years) and 20 control participants (14 men and 6 women; mean age, 46.5 +/- 16.2 years) were evaluated with sonography. Leprosy diagnosis was established on the basis of clinical, bacteriologic, and histopathologic criteria. The reference standard for ulnar neuropathy in this study was clinical symptoms in patients with proven leprosy. The sonographic cross-sectional areas (CSAs) of the ulnar nerve in 3 different regions were obtained. Statistical analyses included Student t tests and receiver operating characteristic curve analysis.
  
  
  RESULTS
  The CSAs of the ulnar nerve were significantly larger in the leprosy group than the control group for all regions (P < .01). Sonographic abnormalities in leprosy nerves included focal thickening (90.5%), hypoechoic areas (81%), loss of the fascicular pattern (33.3%), and focal hyperechoic areas (4.7%). Receiver operating characteristic curve analysis showed that a maximum CSA cutoff value of 9.8 mm(2) was the best discriminator (sensitivity, 0.91; specificity, 0.90). Three patients with normal electrophysiologic findings had abnormal sonographic findings. Two patients had normal sonographic findings, of which 1 had abnormal electrophysiologic findings, and the other refused electrophysiologic testing.
  
  
  CONCLUSIONS
  Sonography and electrophysiology were complementary for identifying ulnar nerve neuropathy in patients with leprosy, with clinical symptoms as the reference standard. This reinforces the role of sonography in the investigation of leprosy ulnar neuropathy.
authors.affiliation: Department of Internal Medicine, University of São Paulo, Ribeirao Preto, Brazil. jejunior@fmrp.usp.br
authors.forename: Jorge
authors.initials: J
authors.lastname: Elias
authors.forename: Marcello Henrique
authors.initials: MH
authors.lastname: Nogueira-Barbosa
authors.forename: Leonir Terezinha
authors.initials: LT
authors.lastname: Feltrin
authors.forename: Renata Bazan
authors.initials: RB
authors.lastname: Furini
authors.forename: Norma Tiraboschi
authors.initials: NT
authors.lastname: Foss
authors.forename: Wilson
authors.initials: W
authors.lastname: Marques
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: dos Santos
mesh_terms: D000293:Adolescent; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D007918:Leprosy / Q000000981:diagnostic imaging*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014459:Ulnar Nerve / Q000000981:diagnostic imaging*; D020424:Ulnar Neuropathies / Q000000981:diagnostic imaging*; D014463:Ultrasonography