Purpose To assess 12-month outcomes and safety of clinical magnetic resonance (MR)–guided focused ultrasound (US) treatments of uterine leiomyomas. Materials and Methods Between March 2005 and December 2009, 150 women with symptomatic uterine leiomyomas were clinically treated with MR-guided focused US at a single institution; 130 patients completed treatment and agreed to have their data used for research purposes. Patients were followed through retrospective review of medical records and phone interviews conducted at 3-, 6-, and 12-month intervals after treatment to assess additional procedures and symptom relief. Outcome measures and treatment complications were analyzed for possible correlations with the appearance of the tumors on T2-weighted imaging. Results The cumulative incidence of additional tumor-related treatments 12 months after MR-guided focused US was 7.4% by the Kaplan–Meier method. At 3-, 6-, and 12-month follow-up, 86% (90 of 105), 93% (92 of 99), and 88% (78 of 89) of patients reported relief of symptoms, respectively. No statistically significant correlation between tumor appearance on T2-weighted imaging and 12-month outcome was found. Treatment-related complications were observed in 17 patients (13.1%): 16 patients had minor complications and one had a major complication (deep vein thrombosis). All complications were resolved within the 12-month follow-up period. Conclusions MR-guided focused US is a noninvasive treatment option that can be used to effectively and safely treat uterine leiomyomas and delivers significant and lasting symptom relief for at least 12 months. The incidence of additional treatment during this time period is comparable with those in previous reports of uterine artery embolization.

We report, for magnetic fields of 0, 8.8, and 14.8 T, measurements of the temperature dependent 63 Cu NMR spin lattice relaxation rate for near optimally doped YBa 2 Cu 3 O 72d , near and above T c . In sharp contrast with previous work we find no magnetic field dependence. We discuss experimental issues arising in measurements of this required precision and implications of the experiment regarding issues including the spin gap or pseudogap. [S0031-9007(98)08138-1] PACS numbers: 74.25.Nf, 74.72.Bk, 76.60.EsA dominant feature of optimally and underdoped cuprates is the appearance of a pseudogap in the normal state excitation spectrum. The microscopic mechanism which is responsible remains a mystery. A number of scenarios for explaining the pseudogap have been proposed (see Ref.[1] for a recent review). However, no calculations of the consequences of a large applied field for the pseudogap have been published. The high magnetic field behavior of the pseudogap provides additional experimental characterization of the pseudogap which is crucial for differentiating between various pictures.We report very high accuracy measurements of the magnetic field dependence of the 63 Cu spin lattice relaxation rate in near optimally doped YBa 2 Cu 3 O 72d . Our measurements demonstrate, in sharp contrast with previous work [2-6], that there is no magnetic field dependence to 63 ͑T 1 T͒ 21 in YBa 2 Cu 3 O 72d . This result has three important ramifications. Although the magnetic fields we apply shift T c down by as much as 8 K, the onset of pseudogap effects does not shift down in temperature. Hence the pseudogap is unrelated to superconducting fluctuations, even in near optimally doped YBa 2 Cu 3 O 72d where the gap behavior appears just above T c . The onset of the pseudogap is very rapid, clearly demonstrating that its magnitude is temperature dependent, opening very rapidly near 110 K. Finally, the absence of any field effect indicates a relatively large energy scale for the gap mechanism. If dynamical pairing correlations or preformed pairs are involved, the length scales must be very short.The 63 Cu NMR spin lattice relaxation rate reveals the spin part of pseudogap behavior, the "spin gap." In underdoped YBa 2 Cu 3 O 6.6 , 63 ͑T 1 T͒ 21 famously exhibits a broad maximum in the vicinity of room temperature and then decreases as T approaches T c from above. In optimally doped YBa 2 Cu 3 O 72d (data shown in Fig.

Uterine fibroids are common smooth muscle tumors, which can result in substantial symptoms affecting the quality of life of women. Whereas patients have several options available for treatment, focused ultrasound ablation is one of the least invasive treatment options outside medical therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging, guidance for therapy, and thermal feedback provided by magnetic resonance imaging. In 2004, the MRgFUS system ExAblate 2000 (InSightec, Haifa, Israel) was approved by the United States Food and Drug Administration for clinical treatments of uterine fibroids. Since its approval, our institution has performed more than 140 treatments. This paper provides an overview of our site's clinical experience with MRgFUS, including a brief description of the treatment system, pertinent features to review on screening magnetic resonance imaging, how the procedure is performed, and risks and benefits of the treatment. Some potential clinical applications of the technology are also briefly reviewed.

Objective To test the hypothesis suggested by previous studies that subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with PD would affect the activity of both motor and non-motor networks, we applied intraoperative fMRI to patients receiving DBS. Patients and Methods Ten patients receiving STN DBS for PD underwent intraoperative 1.5T fMRI during high frequency stimulation delivered via an external pulse generator. The study was conducted between the dates of January 1, 2013 and September 30, 2014. Results We observed blood oxygen level dependent (BOLD) signal changes (FDR<.001) in the motor circuitry, including primary motor, premotor, and supplementary motor cortices, thalamus, pedunculopontine nucleus (PPN), and cerebellum, as well as in the limbic circuitry, including cingulate and insular cortices. Activation of the motor network was observed also after applying a Bonferroni correction (p<.001) to our dataset, suggesting that, across subjects, BOLD changes in the motor circuitry are more consistent compared to those occurring in the non-motor network. Conclusions These findings support the modulatory role of STN DBS on the activity of motor and non-motor networks, and suggest complex mechanisms at the basis of the efficacy of this treatment modality. Furthermore, these results suggest that, across subjects, BOLD changes in the motor circuitry are more consistent compared to those occurring in the non-motor network. With further studies combining the use of real time intraoperative fMRI with clinical outcomes in patients treated with DBS, functional imaging techniques have the potential not only to elucidate the mechanisms of DBS functioning, but also to guide and assist in the surgical treatment of patients affected by movement and neuropsychiatric disorders.

Magnetic resonance imaging-guided focused ultrasound (MRgFUS) ablation of uterine fibroids provides a minimally invasive outpatient technique for targeting and treating symptomatic uterine fibroids. Magnetic resonance imaging provides a guidance platform that has high temporal and spatial resolution for guiding, as well as thermal monitoring of the procedure. The high-intensity focused ultrasound provides a mechanism for delivering large amounts of energy directly into the fibroid without causing detrimental effects to the nontarget tissues. Early and intermediate follow-up of patients treated with MRgFUS provided promising results on the efficacy of the technique for providing symptom relief to patients. As more long-term follow-up data are published, the efficacy of this technique can be compared to more invasive surgical and minimally invasive catheter treatments.

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Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is an investigational therapy for treatment-resistant obsessive-compulsive disorder. The ability of VC/VS DBS to evoke spontaneous mirth in patients, often accompanied by smiling and laughter, is clinically well documented. However, the neural correlates of DBS-evoked mirth remain poorly characterized. Patients undergoing VC/VS DBS surgery underwent intraoperative evaluation in which mirth-inducing and non-mirth-inducing stimulation localizations were identified. Using dynamic causal modeling (DCM) for fMRI, the effect of mirth-inducing DBS on functional and effective connectivity among established nodes in limbic cortico-striato-thalamo-cortical (CSTC) circuitry was investigated. Both mirth-inducing and non-mirth-inducing VC/VS DBS consistently resulted (conjunction, global null, family-wise error-corrected P < 0.05) in activation of amygdala, ventral striatum, and mediodorsal thalamus. However, only mirth-inducing DBS resulted in functional inhibition of anterior cingulate cortex. Dynamic causal modeling revealed that mirth-inducing DBS enhanced effective connectivity from anterior cingulate to ventral striatum, while attenuating connectivity from thalamus to ventral striatum relative to non-mirth-inducing stimulation. These results suggest that DBS-evoked mood elevation is accompanied by distinct patterns of limbic thalamocortical connectivity. Using the novel combination of DBS-evoked mood alteration and functional MRI in human subjects, we provide new insights into the network-level mechanisms that influence affect.