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COMMENTARY |
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Year : 2014 | Volume
: 7
| Issue : 5 | Page : 687-688 |
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High resolution ultrasound and leprosy
Viroj Wiwanitkit
Hainan Medical University, China; Faculty of Medicine, University of Nis, Serbia; Joseph Ayobabalola University, Nigeria
Date of Web Publication | 10-Sep-2014 |
Correspondence Address: Viroj Wiwanitkit Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Wiwanitkit V. High resolution ultrasound and leprosy. Med J DY Patil Univ 2014;7:687-8 |
The article on using "high resolution ultrasound (US) in diagnosis and follow-up of leprosy" is very interesting. [1] In fact, leprosy is still an important tropical infection that can be seen around the world and problematic. Leprosy can be simply diagnosed in severe and disabled cases. However, the aim of controlling of leprosy is to make an early diagnosis, as a secondary prevention. [2] To early diagnose leprosy seems to be a big challenge.
To use the imaging technology for diagnosis of leprosy is an interesting issue. Fornage noted that high solution US was a useful tool for imaging nerve lesions, especially for nerve mass. [3] This is the basic concept that the high solution US can be useful in diagnosis of leprosy. [3] Abnormal epineurium in leprosy can be identified using high solution US. [4] Visser et al. have reported that "strikingly thickened epineurium" was important finding in leprosy. [4] Sometimes, nerve abscess can also be identified. [5] For those cases with nerve abscess, the high solution US finding is "diffuse thickening of the right ulnar nerve with hypoechoic texture housing a cystic lesion with internal debris." [5] Therefore, it is no doubt that high solution US is accepted as a useful tool in the diagnosis of primary neuritic leprosy. [6] It seems that using high solution US could be an answer to the difficulty in leprosy control. Using this tool can help early identify of abnormal nervous structure. Slim et al. proposed that "this is important, because when nerve involvement is diagnosed in time, it may be reversible with adequate treatment." [7]
Nevertheless, there are also some concerns on using high solution US. The "hypoechoic normal structure" is an important problem to be mentioned. [8] This problem can be seen in studying longitudinal structure such as tendon and nerve. Fornage reported that "the obliquity of the US beams in relation to the tendon in longitudinal scans as well as the nonrespect of the strict perpendicularity of the scanning plane in transverse sections result in an artifactual hypoechogenicity." [8] This can be a common cause of false diagnosis in using high solution US.
References | | |
1. | Kharat A, Thakkar DK, Jantre M, Singh A. Role of high resolution ultrasound in diagnoses and follow-up of leprosy patients. Med J Dr. D Y Patil Univ 2014;7:686-7. |
2. | Garbino JA, Marques W Jr, Barreto JA, Heise CO, Rodrigues MM, Antunes SL, et al. Primary neural leprosy: Systematic review. Arq Neuropsiquiatr 2013;71:397-404. |
3. | Fornage BD. Peripheral nerves of the extremities: Imaging with US. Radiology 1988;167:179-82. |
4. | Visser LH, Jain S, Lokesh B, Suneetha S, Subbanna J. Morphological changes of the epineurium in leprosy: A new finding detected by high-resolution sonography. Muscle Nerve 2012;46:38-41. |
5. | Rai D, Malhotra HS, Garg RK, Goel MM, Malhotra KP, Kumar V, et al. Nerve abscess in primary neuritic leprosy. Lepr Rev 2013;84:136-40. |
6. | Jain S, Visser LH, Yerasu MR, Raju R, Meena AK, Lokesh B, et al. Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: A case report. Lepr Rev 2013;84:161-5. |
7. | Slim FJ, Faber WR, Maas M. The role of radiology in nerve function impairment and its musculoskeletal complications in leprosy. Lepr Rev 2009;80:373-87. |
8. | Fornage BD. The hypoechoic normal tendon. A pitfall. J Ultrasound Med 1987;6:19-22. |
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