Imaging techniques in leprosy clinics

Leprosy is the most common treatable peripheral nerve disorder worldwide, with periods of acute neuritis leading to functional impairment of limbs and stigmatizing deformities. The nerve involvement in leprosy reactions, if recognized early and promptly treated with steroids and nerve release surgery, can be reversible. Currently, the nerve assessment in leprosy relies mainly on clinical assessment and nerve conduction studies. High-resolution ultrasonography (HRUS) of peripheral nerves is finding wider application in the differential diagnosis of peripheral neuropathy. HRUS provides a noninvasive tool that gives information on location and degree of nerve enlargement, nerve morphologic alterations, echo texture, fascicular pattern, and vascularity of the nerve, which mirrors the histologic changes. HRUS is amenable to studying structural changes in nerve sites that cannot be biopsied for histopathologic examination and is more cost effective than magnetic resonance imaging. So far other there are only five studies available on the sonographic findings in leprosy. These findings are reviewed and the technique of HRUS is described in this paper, with a recommendation of a standard protocol and proforma.