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

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.