title: New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy.
abstract: To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy.
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurologia, Divisão de Dermatologia, Divisão de Radiologia, ,Ribeirão Preto, SP, Brasil. mandrey@fmrp.usp.br
authors.forename: Marco Andrey Cipriani
authors.initials: MA
authors.lastname: Frade
authors.forename: Marcello Henrique
authors.initials: MH
authors.lastname: Nogueira-Barbosa
authors.forename: Helena Barbosa
authors.initials: HB
authors.lastname: Lugão
authors.forename: Renata Bazan
authors.initials: RB
authors.lastname: Furini
authors.forename: Wilson
authors.initials: W
authors.lastname: Marques Júnior
authors.forename: Norma Tiraboschi
authors.initials: NT
authors.lastname: Foss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019412:Anatomy, Cross-Sectional; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007918:Leprosy / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D010543:Peroneal Nerve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014459:Ulnar Nerve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography; D055815:Young Adult