High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen’s Disease

Dear Editor, It is our pleasure to present a comment on the article by Rai et al.[1] published in March–April 2024 issue of the journal. On using high-resolution ultrasonography (HRUS), Rai et al.[1] reported that the cross-sectional area (CSA) of the ulnar nerve among Indian patients with Hansen’s disease (HD) was significantly thickened in comparison with controls. No difference was found in the CSA of patients on multidrug therapy in comparison with treatment-naïve patients. However, the clinical examination did not detect bilateral nerve enlargement in two patients with pure neuritic HD, while only unilateral nerve thickening was detected clinically. Bilateral thickening was detected on HRUS. They concluded that HRUS is a good noninvasive modality that accurately detects nerve involvement and damage in HD patients.[1] We hereby present a notable limitation. The interpretation of neuromuscular ultrasonographic data needs the use of precise normative CSA reference values (RV). Since these RV are based on numerous variables, such as age, gender, race, and individual’s physique,[2] CSARV have been structured for certain communities.[3,4] In 2022, India provided a useful set of CSA data for nerves, which are used to investigate peripheral nerve disorders in research and clinical fields.[5] The study methodology did not explicitly mention whether Rai et al.[1] referred to a foreign or local CSARV to interpret HRUS data. As a result, that limitation might corrode the genuineness of the study findings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.