Distal Radius

Ulnar Variance: Correlation of Plain Radiographs, Computed Tomography, and Magnetic Resonance Imaging With Anatomic Dissection

Laino DK, Petchprapa CN, Lee SK (NYU Hosp for Joint Diseases) J Hand Surg 37A:90-97, 2012^§

Abstract

Purpose

Several techniques used to measure ulnar variance on a posteroanterior wrist radiograph have been described. It remains unclear whether they accurately represent the true ulnar variance of the patient. The purpose of this study was to correlate ulnar variance measurements on plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and anatomic dissection.

Methods

Posteroanterior (PA) radiographs, coronal and sagittal CT scans, and coronal MRI scans were obtained on 8 fresh-frozen cadaver wrists. The ulnar variance was measured by 5 reviewers. The specimens were then dissected, exposing the wrist joint. The ulnar variance was measured directly on each specimen using digital calipers. The inter-rater reliability was calculated for each imaging modality. The bias for each imaging modality was calculated using the digital caliper measurements as the true ulnar variance.

Results

Intraclass correlation coefficients demonstrated excellent inter-rater reliability for each imaging modality. The average bias from the true variance was the following: PA radiograph, 0.77   mm; coronal CT, 0.96   mm; sagittal CT, 0.96   mm; MRI with articular cartilage, 0.73   mm; MRI excluding cartilage, 0.49   mm. The variance measured on all imaging modalities tended to underestimate the magnitude of the true variance.

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