Magnetic Resonance-guided Focused Ultrasound Surgery Research Articles

P01.03: What maximum measure of fibroid is treatable at the first MRgFUS procedure?

MR-guided focused ultrasound surgery (MRgFUS) is a minimally invasive method for thermal ablation of uterine fibroids. Patients with fibroids of a major axis of 3–12 cm on T2 weighted MRI are considered candidates for the first treatment session with MRgFUS. We investigated whether fibroids of a major axis of over 12.5 cm could be treated successfully. Five patients with fibroids of a major axis over 12.7 cm were treated with the first treatment session of MRgFUS (ExAblate 2000; InSightec). The primary goal was to attain ablative necrosis without severe adverse events. On the display of the FUS workstation, the region of treatment (ROT) was outlined on the coronal plane, as previously described, and the number of spots for sonication emerged thereon. After treatment, the nonperfused volume (NPV) of ablative necrosis was evaluated through contrast enhanced T1-weighted MRI. Fibroid volume before treatment was 677–1,000 cm3; the fibroid major axis, 12.7-15.0 cm; the number of spots sonicated, 131–141; the NPV ratio, 40.2-95.7%; and treatment time, 3:28–3:53 hours. The patient symptoms of heavy menstrual bleeding or pelvic pressure ameliorated one month after the treatment. The outcome was similar to that of fibroids with a major axis under 12 cm. Two patients complaining of a fever over 38 degrees C recovered within 2 days through antibiotics; One of them was in no mood to work for a week due to pain. Another patient with a fibroid of a major axis of 14.3 cm (volume 1,000 cm3) declined treatment in the last stages of 141 sonications because of severe fatigue and lumbar pain; enhanced MR images could not be taken. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

MR-guided focused ultrasound surgery, present and future

MR-guided focused ultrasound surgery (MRgFUS) is a quickly developing technology with potential applications across a spectrum of indications traditionally within the domain of radiation oncology. Especially for applications where focal treatment is the preferred technique (for example, radiosurgery), MRgFUS has the potential to be a disruptive technology that could shift traditional patterns of care. While currently cleared in the United States for the noninvasive treatment of uterine fibroids and bone metastases, a wide range of clinical trials are currently underway, and the number of publications describing advances in MRgFUS is increasing. However, for MRgFUS to make the transition from a research curiosity to a clinical standard of care, a variety of challenges, technical, financial, clinical, and practical, must be overcome. This installment of the Vision 20∕20 series examines the current status of MRgFUS, focusing on the hurdles the technology faces before it can cross over from a research technique to a standard fixture in the clinic. It then reviews current and near-term technical developments which may overcome these hurdles and allow MRgFUS to break through into clinical practice.

Technical Eligibility for Treatment of Magnetic Resonance-guided Focused Ultrasound Surgery

This study was designed to evaluate the technical eligibility for magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment of women with symptomatic fibroids. Technical eligibility for MRgFUS treatment without mitigation techniques was evaluated retrospectively in 783 premenopausal women (median age, 44.2 years) with symptomatic fibroids who applied for uterine artery embolization (UAE) at our institution from 2001 to 2012. Technical eligibility for MRgFUS was defined as primary study endpoint. Technical ineligibility was assessed on the basis of MRI criteria, such as bowel interposition/foreign material in the ultrasound beam path, more than five fibroids, distance from fibroid to sacral bone surface, fibroid size/shape, severe concomitant adenomyosis or extensive cutaneous scars in accordance to the US Food and Drug Administration approvals. Secondary study endpoint was defined as evaluation of the most frequent exclusion criteria and differences in technical eligibility for MRgFUS and UAE. On the basis of MRI, 38.9% of women who applied for UAE were found to be technically eligible for MRgFUS treatment without mitigation techniques. Most frequent reason for ineligibility was bowel interposition in the ultrasound beam path (60.4%). Differences in technical eligibility for MRgFUS (38.9%) and UAE (99.2%) were significant (P < 0.001). MRgFUS treatment is technically possible in up to 40% of women with symptomatic fibroids. The most frequent exclusion criterion is the presence of bowel in the ultrasound beam path.

Magnetic resonance guided focused ultrasound surgery for palliation of painful bone metastasis: Results of a multicenter phase III trial.

9500 Background: Pain due to bone metastases is a common cause of cancer-related morbidity. Magnetic resonance guided focused ultrasound surgery (MRgFUS) is a non-invasive approach to thermal tissue ablation. This multi-center phase III trial assessed efficacy of MRgFUS compared with sham treatment to alleviate pain due to bone metastases. Methods: Subjects with a painful bone metastasis amenable to MRgFUS treatment for whom radiation therapy was ineffective or contraindicated were randomized 3:1 to MRgFUS or sham treatment in a single blind design. Un-blinding of sham subjects who did not experience significant pain relief within 2 weeks was permitted with crossover allowed to salvage MRgFUS treatment. Pain response and impact on quality of life (QOL) were assessed using the numerical rating scale (NRS) and Brief Pain Inventory-Quality of Life (BPI-QOL). Safety was also assessed. Results: 142 randomized subjects were included in an intent-to-treat analysis. 67% (95%CI: 57.5-76.0%) of 107 subjects in the MRgFUS arm experienced clinically significant pain relief, equating with an anchor descriptor of “much improved” or better at 3 months compared to 20% of 35 sham arm subjects (p&lt;0.0001). Median baseline and 3 month NRS scores were 7.0 and 2.0 for the MRgFUS arm vs. 7.0 and 6.0 for the sham arm. A clinically significant improvement at 3 months in BPI-QOL score for MRgFUS but not sham treatment was noted [average change: 2.4 vs. 0.2 respectively, (p&lt;0.0001)]. MRgFUS treatment was well tolerated. Conclusions: MRgFUS, as demonstrated by this phase III trial, results in excellent rates of pain relief and improvement in QOL for patients with oncologic related bone pain who are not candidates for radiation therapy. Given these excellent results coupled with a favorable side effect profile, MRgFUS should be considered a primary choice for this patient population. Clinical trial information: NCT00656305.

An Update on Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids

Magnetic resonance-guided high focused ultrasound surgery (MRgFUS) is a non-invasive treatment option for uterine fibroids. In addition to offering excellent anatomical depiction of the uterine fibroids and uterus, magnetic resonance imaging offers functional imaging and thermal guidance for safe delivery of the focused ultrasound beam. Once appropriately selected for treatment, this out patient treatment option is well tolerated by patients and results in sustained symptom relief. More recent advances in this technology allows for quicker treatment times, allowing for greater nonperfused volumes to be attainable within the allotted scanner time. Also, upon review of fibroid and patient characteristics, the optimal candidates for successful MRgFUS are becoming more established.

Magnetic resonance imaging-guided focused ultrasound surgery for symptomatic uterine fibroids: estimation of treatment efficacy using thermal dose calculations

ObjectiveTo study the correlation between the predicted thermal dose volume (TDV) and the actual ablation volumes in MR-guided focused ultrasound surgery (MRgFUS) for symptomatic uterine fibroids, and to follow up the outcome for 12 months post-treatment. Study designPhase-difference fast spoiled gradient-echo MR images were used to analyze thermal change during the energy deliveries of MRgFUS in 60 consecutive patients treated for symptomatic uterine fibroids. The TDV obtained through analysis of these MR images was compared with the non-perfused volume (NPV) measured on post-treatment contrast enhanced T1-weighted images. Final values of TDV ratio and NPV ratio were obtained by dividing these values by original fibroid volume. Patients were followed for 12 months post-treatment to assess symptomatic relief using the symptom severity score (SSS). ResultsTreatments in which we managed to reach a TDV ratio larger than 27% of the treated fibroid yielded a ratio of NPV to TDV of 1.1±0.5, indicating accurate control of the non-invasive procedure. Patient symptoms, as measured by the SSS, continuously decreased from a mean baseline score of 50±22 to 19±12 (P<0.0001) 12 months post-treatment. ConclusionsAt large treatment volumes (exceeding 27% TDV ratio), thermal dose estimates correspond very closely to non-perfused volumes measured immediately post treatment. These large treatment volumes result in continuous clinical improvement throughout the first 12 months after MRgFUS.

Prospective study on magnetic resonance-guided focused ultrasound surgery for symptomatic uterine fibroid: short-term follow up

To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in treatment of symptomatic uterine leiomyoma among Chinese reproductive age women. From April 2010 to April 2012, 80 premenopausal women with symptomatic leiomyoma volunteered to participate in this prospective study in Department of Outpatient of Peking Union Medical College Hospital. Among 23 reproductive aged patients with size of uterus less than 16th gestational weeks, 2.5 to 10 cm of diameter of myoma, less than 10 myomas and expressing symptoms clearly were treated by MRgFUS. Treatment data, non-perfused volume ratio (NPVR) and adverse events were recorded. After treatment, patients were followed up at 1 week, 1, 3, 6, 12 and 24 months, respectively. Patients at initial screening and each time of the follow-up filled out uterine fibroid symptoms quality of life (UFS-QOL), which include symptoms severity score (SSS) and health-related quality of life (HRQL). The volumes of leiomyoma and uterine were evaluated on MRI before and after the treatment (at 6 and 12 months, respectively). Before operation, routine blood test were performed on all patients, anemia patients at 3 months and 1 year after treatment were checked with blood test. (1) Treatment data and adverse events: the mean therapeutic temperature was (69 ± 7)°C, the mean treatment time was (144 ± 62) min, the mean NPVR was (62 ± 23)%. Adverse events included mild erythema(1/23), abdominal cramp (8/23), vaginal discharge (5/23), and leg numbness (4/23). (2) The rate of secondary surgery: one patient was treated by myoectomy and hysterectomy within one year following up and 4 patients chose surgical treatment during the second-year follow-up. (3) Volume change:the volumes of leiomyoma before the treatment and 6, 12 months after the treatment are 75.6(P25 = 43.8, P75 = 128.9), 52.3(P25 = 23.8, P75 = 111.2), 45.9(P25 = 26.3, P75 = 71.7) cm(3), respectively; and the volumes of uterine before the treatment and 6, 12 months after the treatment are 270.0 (P25 = 208.4, P75 = 390.3), 216.4 (P25 = 151.1, P75 = 290.0), 200.0 (P25 = 149.1, P75 = 267.6) cm(3), respectively. Both leiomyoma and uterine volumes decreased significantly after treatments (P < 0.01). (4) UFS-QOL change:the symptoms severity score (SSS) before the treatment and 3, 12 months after the treatment are (34 ± 13), (22 ± 11), (19 ± 12), which decreased significantly (P < 0.01). The health-related quality of life (HRQL) before the treatment and 3, 12 months after the treatment are (74 ± 15), (82 ± 13), (89 ± 10), which increased dramatically (P < 0.01). (5) Hemoglobin (HGB) change: eleven patients suffered from anemia before treatments, the mean HGB before treatment was (87 ± 6) g/L and were (106 ± 14) g/L 3 months after treatment, (112 ± 10) g/L 12 months after treatment. The HGB was increased significantly after treatments (P < 0.01). MRgFUS is a safe and effective non-invasive management for symptomatic uterine leiomyoma in short-term follow up. But there is additional treatment ratio after MRgFUS.

Magnetic Resonance-guided Focused Ultrasound Treatment for Uterine Fibroids: First Study in Indian Women

Objectives:To study the results of magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment carried out on Indian patients in our Hospital.Materials and Methods:Fifty Indian women (mean age = 36.2 ± 8.3 years) were treated for fibroids as outpatients using the ExAblate MRgFUS system (InSightec). Non-perfused volumes (NPVs) were measured immediately after treatment to calculate the treatment outcomes. A validated symptom-specific questionnaire to record their symptoms prior to treatment and six months following treatment was completed by patients. The size of the fibroids was measured on the day of the treatment and during the 6-month checkup to calculate shrinkage. Adverse events during and following treatment were recorded and monitored.Results:The average NPV ratio measured after the treatment was 88% ± 6%, indicative of high ablated fibroid tissue. Prior to treatment, the mean Symptoms Severity Score was 56.9 ± 4.8 (n = 50), which is indicative of highly symptomatic patients. Six months following treatment, there was an average fibroid shrinkage of 30% ± 11%, and a significant decrease in the mean score to 28.6 ± 6.0 (n = 50) (P < 0.001). There were no reports of serious or unexpected adverse events at any point during treatment or during the follow-up period from any of the 50 women treated in the current study.Conclusions:The current results obtained after 6 months of treatment corroborated previous data on the safety and efficacy of MRgFUS for treating uterine fibroids. This is the first publication that provides such data for a large cohort of Indian women.

Klinische Ergebnisse der Behandlung symptomatischer Uterusmyome mittels MRgFUS (Magnetresonanztomografie-gesteuerter fokussierter Ultraschall)

To investigate the clinical outcome of magnetic-resonance-guided focused ultrasound surgery (MRgFUS) treatment for symptomatic uterine fibroids in premenopausal women using the validated USF-QOL (Uterine Fibroid Symptom and Quality of Life) Questionnaire. 54 patients with symptomatic uterine fibroids were enrolled in this prospective study. The patients completed the UFS-QOL Questionnaire prior to MRgFUS treatment as well as after 3, 6, and 12 months. The rate of technical success was 91.5 % (95.2 % after subtraction of screening errors). 6/54 patients (11 %) had other treatments (surgery, n = 4; UAE, n = 2), 8/54 (15 %) dropped out due to pregnancy, and 8/54 were lost to follow-up. The remaining group showed considerable symptom relief as early as after 3 months. The median overall quality of life score increased from 64.7 (quartile range QR: 49.8 - 77.6) before treatment to 77.6 (QR: 61.4 - 87.1) (p < 0.001), 78.4 (QR: 66.4 - 89.7) (p < 0.001), and 82.8 (QR: 69.8 - 92.2) (p < 0.001) at 3, 6, and 12 months, respectively. The corresponding median symptom severity score decreased from 46.9 (QR: 28.1 - 56.2) to 34.4 (QR: 21.9 - 43.7) at 3 months (p = 0.003) and 28.1 at 6 and 12 months (QR: 18.7 - 38.3, QR: 15.6 - 34.4) (p < 0.001, p = 0.002). The rate of complications requiring treatment was 9 %, and the rate of overall complications was 39 %. No major complications occurred. Our results indicate significant alleviation of fibroid-related symptoms within 12 months of MRgFUS with improvement beginning as early as 3 months after treatment. We observed no major complications, and some women became pregnant after MRgFUS. There was a low treatment failure rate of 11 %.

Potential intracranial applications of magnetic resonance–guided focused ultrasound surgery

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has the potential to create a shift in the treatment paradigm of several intracranial disorders. High-resolution MRI guidance combined with an accurate method of delivering high doses of transcranial ultrasound energy to a discrete focal point has led to the exploration of noninvasive treatments for diseases traditionally treated by invasive surgical procedures. In this review, the authors examine the current intracranial applications under investigation and explore other potential uses for MRgFUS in the intracranial space based on their initial cadaveric studies.

Transcranial magnetic resonance–guided focused ultrasound surgery for trigeminal neuralgia: a cadaveric and laboratory feasibility study

Transcranial MR-guided focused ultrasound surgery (MRgFUS) is evolving as a treatment modality in neurosurgery. Until now, the trigeminal nerve was believed to be beyond the treatment envelope of existing high-frequency transcranial MRgFUS systems. In this study, the authors explore the feasibility of targeting the trigeminal nerve in a cadaveric model with temperature assessments using computer simulations and an in vitro skull phantom model fitted with thermocouples. Six trigeminal nerves from 4 unpreserved cadavers were targeted in the first experiment. Preprocedural CT scanning of the head was performed to allow for a skull correction algorithm. Three-Tesla, volumetric, FIESTA MRI sequences were performed to delineate the trigeminal nerve and any vascular structures of the cisternal segment. The cadaver was positioned in a focused ultrasound transducer (650-kHz system, ExAblate Neuro, InSightec) so that the focus of the transducer was centered at the proximal trigeminal nerve, allowing for targeting of the root entry zone (REZ) and the cisternal segment. Real-time, 2D thermometry was performed during the 10- to 30-second sonication procedures. Post hoc MR thermometry was performed on a computer workstation at the conclusion of the procedure to analyze temperature effects at neuroanatomical areas of interest. Finally, the region of the trigeminal nerve was targeted in a gel phantom encased within a human cranium, and temperature changes in regions of interest in the skull base were measured using thermocouples. The trigeminal nerves were clearly identified in all cadavers for accurate targeting. Sequential sonications of 25-1500 W for 10-30 seconds were successfully performed along the length of the trigeminal nerve starting at the REZ. Real-time MR thermometry confirmed the temperature increase as a narrow focus of heating by a mean of 10°C. Postprocedural thermometry calculations and thermocouple experiments in a phantom skull were performed and confirmed minimal heating of adjacent structures including the skull base, cranial nerves, and cerebral vessels. For targeting, inclusion of no-pass regions through the petrous bone decreased collateral heating in the internal acoustic canal from 16.7°C without blocking to 5.7°C with blocking. Temperature at the REZ target decreased by 3.7°C with blocking. Similarly, for midcisternal targeting, collateral heating at the internal acoustic canal was improved from a 16.3°C increase to a 4.9°C increase. Blocking decreased the target temperature increase by 4.4°C for the same power settings. This study demonstrates focal heating of up to 18°C in a cadaveric trigeminal nerve at the REZ and along the cisternal segment with transcranial MRgFUS. Significant heating of the skull base and surrounding neural structures did not occur with implementation of no-pass regions. However, in vivo studies are necessary to confirm the safety and efficacy of this potentially new, noninvasive treatment.

Magnetic Resonance-guided Focused Ultrasound Surgery for Painful Bone Metastases is a Safe and Effective Treatment in Patients for Whom Radiation Therapy Is Contraindicated: Results of a Multicenter Phase III Trial

Osseous metastases are a daunting problem in oncology. Radiation therapy (RT) is the primary treatment for most patients with painful bone metastases; however, about one-third do not get pain relief and others may have pain recurrence or not be candidates for RT. Magnetic resonance guided focused ultrasound surgery (MRgFUS) combines non-invasive focused ultrasound with MR guidance. Phase I-II studies demonstrated that MRgFUS resulted in high rates of pain relief with an excellent safety profile.

Clinical Experience With the Use of Magnetic Resonance Guided Focused Ultrasound Surgery (MRGFUS) System for Focal Treatment of Low-Risk Prostate Cancer

To evaluate the safety and preliminary efficacy of focal therapy using MRGFUS system with a designated endorectal transducer and real time MR thermometry for treatment of patients with low-risk, organ-confined prostate cancer. We were the first to use the system with a 1.5 T GE MRI, for treating patients with locally-confined low-risk prostate cancer.

Experience of Treating Painful Bone Metastases With Magnetic Resonance Guided Focused Ultrasound

Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) is an innovative technology combining non-invasive deposition of high intensity focused ultrasound energy into a specified target inside the body, with high resolution Magnetic Resonance Imaging (MRI) guidance and real-time thermal feedback. This unique combination enables precise treatment planning, targeting, and conduction with continuous control for case-specific customization. We present here results of a clinical trial conducted in our facility.

Inverse design of an organ-oriented RF coil for open, vertical-field, MR-guided, focused ultrasound surgery

The advantages of open, vertical-field, magnetic resonance-guided, focused ultrasound surgery (MRgFUS) are attractive. The inverse technique using the bi-boundary conditions is proposed to design a uterine-oriented intraoperative RF coil with an ultrasound aperture for the MRgFUS system. In the current proposed scheme, the desired magnetic field of the RF coil was set to completely overlap the target organ. The current density distribution on the RF coil surface, accounting for the expected magnetic field, was solved using the inverse technique. The stream function was available through the ‘discretization’ of the current density distribution on the RF coil surface. The coil windings were obtained from the contour plot of the stream function. As a modification of previous designs, the bi-boundary conditions are proposed in the inverse technique for the existence of the ultrasound aperture. Based on the obtained coil windings, a prototype coil was constructed. MR imaging of the phantom and the human body was performed to show the efficacy of the prototype coil. The results of temperature measurement using the prototype coil in a 0.4-T MR system were satisfactory. The performance of the prototype coil improved compared with the previously reported design.

Diagnostic Imaging and Image-Guided Therapy of Skeletal Metastases

The high incidence of skeletal metastases in cancer patients warrants careful detection with imaging and follow-up. Efforts are needed to manage pain associated with skeletal metastases as part of overall patient management. This article reviews the current methods of diagnostic imaging in the evaluation of skeletal metastases and image-guided treatment of bone metastases for the palliation of pain based primarily on the assessment of imaging and interventional radiologic literature. Approaches to diagnostic imaging of skeletal metastases are summarized. Skeletal scintigraphy provides high sensitivity for detecting skeletal metastases, but targeted computed tomography (CT) or magnetic resonance imaging (MRI) may be needed to increase specificity. Newer imaging modalities, such as positron emission tomography (PET)/CT, improve detection of both lytic and blastic metastases. Minimally invasive percutaneous ablative treatment techniques, including radiofrequency ablation, microwave ablation, and cryoablation, are examined. They provide alternative approaches to radiation therapy to effectively palliate pain of bone metastases. Preliminary results of MR-guided focused ultrasound surgery (MRgFUS) demonstrate its effectiveness in palliating pain from skeletal metastases. Skeletal scintigraphy is the most common imaging modality for detecting skeletal metastases. Additional imaging may be required based on the type of tumor, the disease state, or treatment options. External-beam radiation therapy remains the mainstay for palliation of pain from bone metastases. Alternative minimally invasive and noninvasive image-guided treatment options can provide effective pain palliation.

Ultrasound- and MR-guided focused ultrasound surgery for prostate cancer

Prostate cancer (PC) is one of the most frequently diagnosed cancers in men. There are a number of treatment options for PC with a different therapeutic approach between USA and Europe. Radical prostatectomy is one of the most used therapies but focal gland therapy is an emerging approach, especially for localized tumors. In this scenario, high intensity focused ultrasound (HIFU) has been incorporated in certain medical association guidelines. HIFU has been employed for about 10 years especially for localized PC. Results are promising with a 5-year biochemical survival rate ranging from 45% to 84%. Collateral events are rare and HIFU retreatment is not common. Magnetic resonance guided focused ultrasound surgery (MRgFUS) was recently presented as a method for ablation with focused ultrasound under magnetic resonance imaging guidance. It has the advantage of improved targeting and real time temperature monitoring but only a few studies have been conducted with human patients. The aim of this review is to describe the current status of HIFU and MRgFUS in the therapy of PC.

Numerical optimization of a three‐channel radiofrequency coil for open, vertical‐field, MR‐guided, focused ultrasound surgery using the hybrid method of moment/finite difference time domain method

The numerical optimization of a three-channel radiofrequency (RF) coil with a physical aperture for the open, vertical-field, MR-guided, focused ultrasound surgery (MRgFUS) system using the hybrid method of moment (MoM)/finite difference time domain (FDTD) method is reported. The numerical simulation of the current density distribution on an RF coil with a complicated irregular structure was performed using MoM. The electromagnetic field simulation containing the full coil-tissue interactions within the region of interest was accomplished using the FDTD method. Huygens' equivalent box with six surfaces smoothly connected the MoM and FDTD method. An electromagnetic model of the human pelvic region was reconstructed and loaded in the FDTD zone to optimize the three-channel RF coil and compensate for the lower sensitivity at the vertical field. In addition, the numerical MoM was used to model the resonance, decoupling and impedance matching of the RF coil in compliance with engineering practices. A prototype RF coil was constructed to verify the simulation results. The results demonstrate that the signal-to-noise ratio and the homogeneity of the B(1) field were both greatly improved compared with previously published results.

Mitigation of Abdominal Scars during Magnetic Resonance-Guided Focused Ultrasound Treatment of Uterine Fibroids, Using an Energy- Blocking Scar Patch

Previously, abdominal scars were considered a contraindication to Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) of uterine fibroids, if they were in the energy beam path. The purpose of this study was to assess the clinical potential of an energy-blocking scar patch for MRgFUS of uterine fibroids in patients with abdominal scars.

Primeros 3 casos en España de gestación a término tras tratamiento de miomas mediante cirugía no invasiva MRgFUS

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive surgical technique based on thermal coagulative necrosis of tissue by focused ultrasound guided by magnetic resonance. This fairly recent technique was approved by the American Food and Drug Administration in 2004 and by the European Union in 2006 for the treatment of uterine fibroids. In 2010 MRgFUS was approved by the European Union (CE label) for the treatment of adenomyosis and is being developed for the non-invasive treatment of other tumoral diseases, mainly in oncology. We present the first three cases of pregnancy achieved at the Instituto Cartuja, the only site in Spain with MRgFUS technology. We conclude that MRgFUS is a safe, reliable and effective technique for the treatment of uterine fibroids, even in women with a desire to preserve fertility.