Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients.

OBJECTIVE: The purpose of this study was to assess the degree of leiomyoma ablation and shrinkage after MRI-guided focused ultrasound treatment performed according to U.S. Food and Drug Administration protocols for commercial trials. MATERIALS AND METHODS: A total of 147 symptomatic leiomyomas in 80 women (average age, 46 years; range, 34-55 years) were managed with MRI-guided focused ultrasound. The average volume of treated fibroids was 175+/-201 (SD) cm3. Before treatment, T2-weighted MR images in three planes were obtained to measure leiomyoma volume. Immediately after treatment, T1-weighted contrast-enhanced fat-suppressed MR images in three planes were used to measure nonperfused volume ratio. Similar images obtained 6 months after treatment were used to determine leiomyoma shrinkage. Qualitative and quantitative relations between fibroid volume, nonperfused volume ratio at treatment, and 6-month shrinkage were measured. RESULTS: The average nonperfused volume ratio was 55%+/-25% immediately after treatment. Six months after treatment, the average volume of treated fibroids had decreased to 112+/-141 cm3 (n=81) (p<0.0001) with an average volume reduction of 31%+/-28%. A linear regression model showed highly significant correlation between posttreatment nonperfused volume ratio and shrinkage at 6 months (p<0.0001). CONCLUSION: MRI-guided focused ultrasound therapy for leiomyoma can result in nonperfused volume ratio and shrinkage that exceed those in previous clinical trials because the treatment guidelines have been relaxed to allow a greater amount of tissue ablation. The results suggest that a larger nonperfused volume ratio can be achieved, resulting in greater shrinkage and improved relief of symptoms.

Coordination dynamics of large-scale neural circuitry underlying rhythmic sensorimotor behavior.

In coordination dynamics, rate is a nonspecific control parameter that alters the stability of behavioral patterns and leads to spontaneous pattern switching. We used fMRI in conjunction with measures of effective connectivity to investigate the neural basis of behavioral dynamics by examining two coordination patterns known to be differentially stable (synchronization and syncopation) across a range of rates (0.75 to 1.75 Hz). Activity in primary auditory and motor cortices increased linearly with rate, independent of coordination pattern. On the contrary, activity in a premotor-cerebellar circuit varied directly with the stability of the collective variable (relative phase) that specifies coordinated behavioral patterns. Connectivity between premotor and motor cortices was also modulated by the stability of the behavioral pattern indicative of greater reliance on sensorimotor integration as action becomes more variable. By establishing a critical connection between behavioral and large scale brain dynamics, these findings reveal a basic principle for the neural organization underlying coordinated action.

Multisensory integration for timing engages different brain networks.

How does the brain integrate information from different senses into a unitary percept? What factors influence such multisensory integration? Using a rhythmic behavioral paradigm and functional magnetic resonance imaging, we identified networks of brain regions for perceptions of physically synchronous and asynchronous auditory-visual events. Measures of behavioral performance revealed the existence of three distinct perceptual states. Perception of asynchrony activated a network of the primary sensory, prefrontal, and inferior parietal cortices, perception of synchrony disengaged the inferior parietal cortex and further recruited the superior colliculus, and when no clear percept was established, only the residual areas comprised of prefrontal and sensory areas were active. These results indicate that distinct percepts arise within specific brain sub-networks, the components of which are differentially engaged and disengaged depending on the timing of environmental signals.

A prospective functional MR imaging study of mild traumatic brain injury in college football players.

BACKGROUND AND PURPOSE: Although concussion is common among athletes, evidence-based methods for clinical evaluation, treatment, and recovery are lacking. We used a prospective, functional neuroimaging approach to assess sports-related concussion in which imaging was performed before injury so that brain changes resulting from concussion could be better understood. METHODS: Neurophysiologic correlates of sports-related concussion were investigated in eight college football players by using functional MR imaging. Preseason baseline levels of blood oxygen level-dependent (BOLD) activity were acquired during the performance of a test battery that included mathematical, memory, and sensorimotor coordination tasks. Four players who had a concussion repeated these baseline procedures within 1 week of injury. The remaining control players were retested at the end of the season. RESULTS: Specific neural signatures of concussion were detected in individual players by comparing postconcussion results to preconcussion baseline values. The validity of these indicators was confirmed by comparing them with the same measures in noninjured control subjects. When compared with control subjects, concussed players had marked within-subject increases in the amplitude and extent of BOLD activity during a finger-sequencing task. Effects were observed primarily in the parietal and lateral frontal and cerebellar regions. CONCLUSION: Differences in neural functioning were observed in the absence of observed deficits in behavioral performance, suggesting that this approach may increase sensitivity to concussion compared with neuropsychological evaluation alone. Though preliminary, the proposed prospective neuroimaging approach may have great potential for understanding mild traumatic brain injury and identifying mechanisms underlying recovery.

Brain networks underlying human timing behavior are influenced by prior context.

The continuation paradigm is often used to investigate the behavioral and neural mechanisms of timing. Typically, a movement rate is established by pacing with a metronome. Then, the metronome is turned off and the subject continues at the established rate. Performance during continuation is assumed to be based on internal timing mechanisms. Here, we investigated the degree to which the neural activity underlying time representation depends on the initial pacing context, that is, whether pacing was established by moving in-phase (the usual procedure) or anti-phase (syncopation) with an auditory metronome. Functional MRI was measured from 14 subjects during four conditions: synchronized pacing, synchronized continuation, syncopated pacing, and syncopated continuation. In general, movements were timed consistently for all four conditions. However, a much broader network of activation was engaged during syncopation compared with synchronization, including increased activation in supplementary motor area, left premotor area, right thalamus, bilateral inferior frontal gyrus, and cerebellum. No differences were found when comparing continuation with the preceding pacing phase except for decreased activity in auditory-related regions due to the absence of the metronome. These results demonstrate that the cortical and subcortical areas recruited to support a simple motor timing task depend crucially on the method used to establish the temporal reference. Thus, the neural mechanisms underlying time and timing are highly flexible, reflecting the context in which the timing is established.

Cortical and subcortical networks underlying syncopated and synchronized coordination revealed using fMRI. Functional magnetic resonance imaging.

Inherent differences in difficulty between on the beat (synchronization) and off the beat (syncopation) coordination modes are well known. Synchronization is typically quite easy and, once begun, may be carried out with little apparent attention demand. Syncopation tends to be difficult, even though it has been described as a simple, phase-shifted version of a synchronized pattern. We hypothesize that syncopation, unlike synchronization, is organized on a cycle-by-cycle basis, thereby imposing much greater preparatory and attentional demands on the central nervous system. To test this hypothesis we used fMRI to measure the BOLD response during syncopation and synchronization to an auditory stimulus. We found that the distribution of cortical and subcortical areas involved in intentionally coordinating movement with an external metronome depends on the timing pattern employed. Both synchronized and syncopated patterns require activation of contralateral sensorimotor and caudal supplementary motor cortices as well as the (primarily ipsilateral) cerebellum. Moving off the beat, however, requires not only additional activation of the cerebellum but also the recruitment of another network comprised of the basal ganglia, dorsolateral premotor, rostral supplementary motor, prefrontal, and temporal association cortices. No areas were found to be more active during synchronization than syncopation. The functional role of the cortical and subcortical regions areas involved in syncopation supports the hypothesis that whereas synchronization requires little preparation and monitoring, syncopated movements are planned and executed individually on each perception-action cycle.