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LETTER TO THE EDITOR  
Year : 2016  |  Volume : 26  |  Issue : 3  |  Page : 418-419
Significance of color doppler imaging in leprosy


Department of Radiology, Seth GSMC and KEM Hospital, Mumbai, India

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Date of Web Publication14-Sep-2016
 

How to cite this article:
Aswani Y. Significance of color doppler imaging in leprosy. Indian J Radiol Imaging 2016;26:418-9

How to cite this URL:
Aswani Y. Significance of color doppler imaging in leprosy. Indian J Radiol Imaging [serial online] 2016 [cited 2020 Feb 23];26:418-9. Available from: http://www.ijri.org/text.asp?2016/26/3/418/190410
Sir,

I read with great interest the article titled, “Role of ultrasound in evaluation of peripheral nerves” by Lawande et al. in the July–September 2014 issue of the Indian Journal of Radiology and Imaging, Volume 24, Issue 3.[1] The article is informative and intelligently written with excellent depiction of pathologies on ultrasound. However, I would like to make the following contributions.

In the section on “Infective lesions” in the manuscript, the authors mention that there is presence of increased peri-, endoneural vascularity on Doppler in leprosy affected nerves.[1] This, however, is not in accordance with the prevailing body of literature.[2],[3] In the study conducted by Jain et al.[2] and Martinoli et al.,[3] none of the patients with leprosy had an increase in neural vascularity. Increased vascularity in peri-, endoneurium, unlike nerve enlargement and architectural distorsion, is both a marker of acute neuritis as well as a differentiating factor between leprosy and leprosy-associated lepra reactions (an immunologically mediated inflammatory state during leprosy).[2],[3] The differentiation is critical on account of two reasons; first, increased vascularity suggests lepra reactions, identification of which should prompt immediate antireaction therapy.[4] Failure to institute immediate treatment may result in irreversible nerve damage; sometimes in as less as 24 hours within the onset of lepra reactions.[4] Second, lepra reactions are characterized by recurrence.[2],[4] Hence, ultrasound depiction of neural vascularity may help guide the duration of antireaction therapy.[2] Recurrence is postulated to occur because the treatment is discontinued on clinical betterment without ultrasound evidence of nondetection of vascularity on Doppler.[2] Lepra reactions are potentially treatable, fairly common, and are a cause of significant morbidity.[4]

To conclude, an increased vascularity on Doppler interrogation helps differentiate leprosy from lepra reactions and is a marker of acute neuritis.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lawande AD, Warrier SS, Joshi MS. Role of ultrasound in evaluation of peripheral nerves. Indian J Radiol Imaging 2014;24:254-8.  Back to cited text no. 1
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2.
Jain S, Visser LH, Praveen TL, Rao PN, Surekha T, Ellanti R, et al. High-resolution sonography: A new technique to detect nerve damage in leprosy. PLoS Negl Trop Dis 2009;3:e498.  Back to cited text no. 2
[PUBMED]    
3.
Martinoli C, Derchi LE, Bertolotto M, Gandolfo N, Bianchi S, Fiallo P, et al. US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol 2000;29:142-50.  Back to cited text no. 3
[PUBMED]    
4.
Gelber RH. Leprosy (Hansen's Disease). In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL Jameson JL, editors. Harrison's principles of Internal Medicine, Vol 1, 17th ed. USA: Mc Graw-Hill Companies; 2008. p. 1021-6.  Back to cited text no. 4
    

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Correspondence Address:
Yashant Aswani
Department of Radiology, Seth GSMC and KEM Hospital, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.190410

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