One of the stress sources that can be used in dynamic elastography imaging methods is the acoustic radiation force. However, displacements of the medium induced by this stress field are generally not fully understood in terms of spatial distribution and temporal evolution. A model has been developed based on the elastodynamic Green's function describing the different acoustic waves generated by focused ultrasound. The function is composed of three terms: two far-field terms, which correspond to a purely longitudinal compression wave and a purely transverse shear wave, and a coupling near-field term which has a longitudinal component and a transverse component. For propagation distances in the shear wavelength range, the predominant term is the near field term. The displacement duration corresponds to the propagation duration of the shear wave between the farthest source point and the observation point. This time therefore depends on the source size and the local shear modulus of the tissue. Evolution of the displacement/time curve profile, which is directly linked to spatial and temporal source profiles, is computed at different radial distances, for different durations of force applications and different shear elastic coefficients. Experimental results performed with an optical interferometric method in a homogeneous tissue-mimicking phantom agreed with the theoretical profiles.

PurposeThe aim of this prospective study was to evaluate whether [18F]FDG-PET/CT, performed within two weeks of starting erlotinib therapy can predict tumor response defined by RECIST 1.1 criteria after 8 weeks of treatment in patients with inoperable (stage IIIA to IV) non-small cell lung cancer patients.Patients and MethodsThree [18F]FDG-PET/CT scans were acquired in 12 patients before (5±4 days) and after 9±3 days (early PET) and 60±6 days (late PET) of erlotinib therapy. Conventional evaluation, including at least chest CT (baseline versus after 8 weeks of treatment), was performed according to RECIST 1.1 criteria. Change in [18F]FDG uptake was compared with conventional response, progression-free survival (PFS), and overall survival (OS).ResultsBy using ROC analysis, the Area Under the Curve for prediction of metabolic non-progressive disease (mNP) by early PET was 0.86 (95% CI, 0.62 to 1.1; P = 0.04) at a cut-off of 21.6% reduction in maximum Standardized Uptake Value (SUVmax). This correctly classified 11/12 patients (7 with true progressive disease; 4 with true non-progressive disease; 1 with false progressive disease). Non-progressive disease after 8 weeks of treatment according to RECIST 1.1 criteria was significantly more frequent in patients classified mNP (P = 0.01, Fisher's exact test). mNP patients showed prolonged PFS (HR = 0.27; 95% CI, 0.04 to 0.59; P<0.01) and OS (HR = 0.34; 95% CI, 0.06 to 0.84; P = 0.03). Late PET analysis provided concordant results.ConclusionMorphologic response, PFS and OS survival in non-small cell lung cancer patients can be predicted by [18F]FDG-PET/CT scan within 2 weeks after starting erlotinib therapy.

DeltaPOP can be determined in the operating room and is influenced by changes in preload. This new index has potential clinical applications for the prediction of fluid responsiveness.