High-Resolution Ultrasound for Differentiation Between Leprosy-Associated Neuropathy and Vasculitic Peripheral...

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Leprosy-associated neuropathy and vasculitic neuropathy (VN) present similar clinical symptoms, complicating diagnosis in non-endemic areas.
• High-resolution ultrasound (HRUS) shows potential for differentiating these neuropathies, but comparative data is scarce.

Purpose of the Study:

• To characterize and compare HRUS findings in biopsy-confirmed leprosy-associated neuropathy and VN.
• To identify distinct sonographic features for early differential diagnosis between leprosy and VN.

Main Methods:

• Retrospective analysis of 12 patients with biopsy-confirmed neuropathy (3 leprosy, 9 VN).
• Standardized clinical assessments, nerve conduction studies, and HRUS of peripheral nerves, cervical roots, and brachial plexus.
• Measurement of nerve cross-sectional areas (CSA) and assessment of intraneural vascularization using Power Doppler.

Main Results:

• Leprosy patients exhibited moderate-to-marked nerve enlargement proximal to entrapment sites with 100% intraneural vascularization.
• Vasculitic neuropathy patients showed mild-to-moderate enlargement in non-entrapment regions with variable vascularization (25-83.3%).
• Lower limb nerve enlargement was specific to leprosy; brachial plexus/cervical root involvement was rare in both.

Conclusions:

• Distinct HRUS patterns can aid in differentiating leprosy-associated neuropathy from VN.
• Marked nerve enlargement near entrapment sites and increased vascularization suggest leprosy, while mild, non-entrapment enlargement indicates VN.