SALT LAKE CITY - The name Jim Shea Jr. is now undeniably associated with the sport of skeleton. When people think figure skating wunderkind, it's a good bet Sarah Hughes comes to mind.
At the Olympic Polyclinic, musculoskeletal ultrasound means Dr. Bill Middleton. In fact, the professor of radiology from the Mallinckrodt Institute in St. Louis was referred to as "the ultrasound guy" by many of his colleagues. Middleton doesn’t seem to mind being the champion of bone and joint ultrasound.
"There are unique things that you can learn from ultrasound. We know that ultrasound, in our hands (at Mallinckrodt), is a little bit better for rotator cuff problems. It’s very good for tendon disease in general and it’s very good at evaluating masses in the extremities and, to a certain extent, ligaments," he said.
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| Mallinckrodt radiologist Dr. Bill Middleton is a champion of musculoskeletal ultrasound. |
Other advantages of the modality include its lower cost, its ease on the patient, and its ability to pinpoint superficial injuries with high-frequency transducers for high-resolution images, Middleton noted.
In one instance at the Polyclinic, ultrasound bested MRI, in Middleton’s estimation. He cited the case of a ski jumper who was experiencing pain at the point where his boot hit the top of his shin.
"Clinically, there was a little swelling and a lot of pain, but they weren’t sure if it was a muscle tear or some sort of bony abnormality. It was clear from the ultrasound that the muscle was entirely normal," Middleton said. "There was a lot of swelling in the superficial soft tissues that accounted for what he was feeling. We also had a little bit of periosteal reaction in the underlying tibia, and a little bit of subperiosteal fluid of the tibia. That was just plain as day on ultrasound."
"Then we did his MRI and, knowing that we had those findings on the ultrasound, you could see it on the MRI," he said. "But it would have been something that would be easy to de-emphasize on the MRI. The MRI shows you everything, and you don’t really focus on a particular area so it doesn’t look as obvious."
Not that Middleton is discounting musculoskeletal MRI completely. Agreement between MR and sonographic scans at the Polyclinic has been good, and MR certainly has its strong points, particularly for deep-tissue imaging. "We did a nice case this morning on a talofibular ligament that was very abnormal and very obvious on the ultrasound. It correlated nicely with the MR exam," he said, adding that MR is also better for scanning large areas of the body.
Middleton revealed that, when he was invited to work at the Polyclinic, he had to seriously consider whether to accept, as the deadline was approaching for a textbook he is writing.
"When Julia (Crim) asked me, I had to decide ‘Do I want to do this because I’m in the middle of crunch time for the book?’ But it’s such a unique opportunity," he said. "I decided I’ll just use all of my spare time to work on the chapters."
The topic of Middleton’s forthcoming tome? Ultrasound, of course.
By Shalmali Pal
AuntMinnie.com staff writer
February 24, 2002
Copyright © 2002 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
