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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1201-1209 • 0278-4297

Role of Ulnar Nerve Sonography in Leprosy Neuropathy With Electrophysiologic Correlation

Jorge Elias, Jr, MD, PhD, Marcello Henrique Nogueira-Barbosa, MD, PhD, Leonir Terezinha Feltrin, MD, Renata Bazan Furini, MD, Norma Tiraboschi Foss, MD, PhD, Wilson Marques, Jr, MD, PhD and Antonio Carlos dos Santos, MD, PhD

Divisions of Radiology (J.E., M.H.N.-B., L.T.F., A.C.d.S.) and Dermatology (R.B.F., N.T.F.), Department of Internal Medicine, and Department of Neurology (W.M.), School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.

Address correspondence to Jorge Elias, Jr, MD, PhD, Division of Radiology, Department of Internal Medicine, School of Medicine of Ribeirao Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirao Preto, 14049-090 São Paulo–SP, Brazil., E-mail: jejunior{at}fmrp.usp.br

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 mm2 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.

Key Words: electrophysiologic test • leprosy neuropathy • peripheral nerve • sensitivity and specificity • sonography

Abbreviations: CMAP, composed muscle action potential • CSA, cross-sectional area • MaxCSA, maximum cross-sectional area

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.