Application of point-of-care ultrasound in patients receiving enteral nutrition.

OBJECTIVE: Enteral nutrition (EN) is the first-choice nutritional support, as it is more in line with normal physiological processes. During EN, the major goals to achieve include accurate confirmation of the feeding tube position, monitoring the gastric residual volume, assessing gastrointestinal motility, and monitoring the nutritional status of patients. With rapid development in technology, point-of-care ultrasound (POCUS) has become a more convenient and effective technical tool for monitoring critically ill patients receiving EN. In this review, we have summarized and discussed the value of POCUS in the implementation, monitoring, and evaluation of EN therapy to provide a reference for nutritional support of critically ill patients in critical care settings. MATERIALS AND METHODS: This is a narrative review. A literature search for Scopus-indexed articles was performed randomly using PubMed and MEDLINE databases as the primary sources. No specific term was used for the search. RESULTS: POCUS can be used for positioning of nasogastric and nasointestinal tubes, evaluation of gastric residuals and gastrointestinal motility as well as monitoring of nutritional status. CONCLUSIONS: POCUS is a real-time, highly repeatable, radiation-free, and non-invasive visual inspection technique, with high application value in assessing the nutritional status of patients receiving EN and guiding the development of further nutritional treatment plans. It is an important diagnostic and monitoring tool that can be used by the clinicians in the ICU.

Colorectal anastomosis after laparoscopic extended left colectomy: techniques and outcome.

AIM: After extended left colectomy, traditional colorectal anastomosis is often not feasible because of insufficient length of the remaining colon to perform a tension-free anastomosis. Total colectomy with ileorectal anastomosis could be an alternative but this can lead to unsatisfactory quality of life. Trans-mesenteric colorectal anastomosis or inverted right colonic transposition (the so-called Deloyers procedure) are two possible solutions for creating a tension-free colorectal anastomosis after extended left colectomy. Few studies have reported their results of these two techniques and mostly via laparotomy. The aim of this study was to describe the trans-mesenteric colorectal anastomosis and the inverted right colonic transposition procedure via a laparoscopic approach and report the outcome in a series of 13 consecutive patients. METHOD: This was retrospective chart review of laparoscopic colorectal surgery with trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure from January 2015 up to 2019. An accompanying video demonstrates these two techniques. RESULTS: Thirteen consecutive patients underwent either a laparoscopic trans-mesenteric colorectal anastomosis (n = 9) or an inverted right colonic transposition procedure (n = 4). One patient had intra-operative presacral bleeding that was stopped successfully without conversion. Two patients had a postoperative intra-abdominal abscess, but no anastomotic complications were recorded. The median number of bowel movements per day after 6 months was 2 (range 2-5). CONCLUSIONS: Trans-mesenteric colorectal anastomosis or the inverted right colonic transposition procedure is feasible laparoscopically. The now well-established classical advantages of the laparoscopic approach are associated with good functional outcome after these procedures.

Long non-coding RNAs associated with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is one of the most common and fatal diseases in the head and neck region worldwide. To better understand the carcinogenesis and to find efficient biomarkers and therapeutic targets are still in urgent need. The studies of expression profile and mechanisms of long non-coding RNAs (lncRNAs) develop fast in recent years. This molecule form is aberrantly expressing and influencing many cellular processes in different cancer types. But its expression pattern and association with oral squamous cell carcinoma are yet to be elucidated. Here we reviewed recently reported OSCC-related lncRNAs and their relationship with the clinical status of patients. Functional mechanisms were also discussed. With the emerging knowledge and techniques in this area, more efficient biomarkers and therapeutic targets are promising in the future.

[Relationship between expression level of sex-determining region Y box 9 and metastasis of oral squamous cell carcinoma].

Objective: To investigate the effects of sex-detemining region Y box9 (SOX9) expression levels on the proliferation, migration and metastasis in oral squamous cell carcinoma (OSCC). Methods: A total of 74 OSCC pathological specimens were collected from Shanghai OSCC Tissue and Biological Informations Bank, and clinicopathological information of these specimens were collected. Immunohistochemistry assay was used to examine the expression levels of SOX9 in OSCC and to analyze their relationship with clinicopathological features. Cell counting kit-8 assay and cloning formation was used to observe the relationship between the expression levels of SOX9 and the proliferation of OSCC. Transwell experiment and scratch test were used to detect the difference of the ability of OSCC in cell lines with different expression levels of SOX9. Results: The risk of lymph node metastasis in patients with high expression of SOX9 was significantly increased (P=0.010). In the Transwell experiment, the number of HN6 cells (671.0±57.4, P=0.000) migrated to the lower chamber more than that of CAL27 cells (172.0±13.9). In the scratch experiment, HN6 cells [0 h: (93.7±2.1) µm; 6 h: (56.7±2.5) µm; 12 h: (29.7±3.1) µm] migrated faster than CAL27 [0 h: (93.7±1.5) µm; 6 h: (78.0±2.0) µm; 12 h: (42.0±3.0) µm](P<0.05). The migration ability of the cell line (HN6) with high-expression of SOX9 was significantly higher than that in cell line (CAL27) with low-expression SOX9 (P<0.05). The expression levels of SOX9 in OSCC were no significant on cell proliferation (P>0.05). Conclusions: High expression of SOX9 can promote the migration and lymph node metastasis of OSCC. SOX9 is a candidate gene target for the diagnosis and intervention of lymph node metastasis in OSCC.

Eradication of hepatitis C virus profoundly prolongs survival in hepatocellular carcinoma patients receiving transarterial chemoembolization.

Adjuvant pegylated interferon plus ribavirin treatment (PegIFN/RBV) reduces recurrence and prolongs survival in early stage hepatocellular carcinoma (HCC) patients with chronic hepatitis C (CHC) infection receiving resection or ablation. However, the impact of antiviral therapy in intermediate and advanced stage of CHC-HCC patients is uncertain. This study aimed to investigate the impact PegIFN/RBV treatment on recurrence-free interval and survival in patients with HCC receiving transarterial chemoembolization (TACE). From 2010 to 2013, 274 CHC patients from a 1073 patient-based cohort composed of freshly diagnosed HCC and receiving TACE treatment the Chang Gung Memorial Hospital, Linkou Medical Center were recruited. Propensity score matching (PSM) (age, gender, AST to Platelet Ratio Index (APRI), tumour size, tumour number and Child-Turcotte-Pugh score) with the ratio 1:2 for patients with and without PegIFN/RBV treatment was performed. Statistics were performed with SPSS V.20 (IBM, USA). After matching, 153 patients were analysed and 27 patients (17.6%) achieved sustained virologic response (SVR). The 2-year cumulative overall survival rate and recurrence-free survival rate among patients with SVR, non-SVR, and untreated were 85.2% vs 58.3% vs 69.6% (P=.001) and 73.3% vs 53.8% vs 58.5% (P=.013). By Cox regression analysis, non-SVR, untreated, increase CTP score and nonresponder to TACE were independent factors related to mortality. The SVR achieved by PegIFN/RBV treatment markedly improves survival and reduces tumour recurrence in CHC-HCC patients receiving TACE treatment after complete response.

Achromatic Metalens over 60 nm Bandwidth in the Visible and Metalens with Reverse Chromatic Dispersion.

In this Letter, we experimentally report an achromatic metalens (AML) operating over a continuous bandwidth in the visible. This is accomplished via dispersion engineering of dielectric phase shifters: titanium dioxide nanopillars tiled on a dielectric spacer layer above a metallic mirror. The AML works in reflection mode with a focal length independent of wavelength from λ = 490 to 550 nm. We also design a metalens with reverse chromatic dispersion, where the focal length increases as the wavelength increases, contrary to conventional diffractive lenses. The ability to engineer the chromatic dispersion of metalenses at will enables a wide variety of applications that were not previously possible. In particular, for the AML design, we envision applications such as imaging under LED illumination, fluorescence, and photoluminescence spectroscopy.

[Up-regulation of DLK1 in non-small cell lung cancer and the relevant molecular mechanism].

OBJECTIVE: To explore the expression of delta-like 1 homolog (DLK1) gene in non-small cell lung cancer (NSCLC) and its regulatory mechanism. METHODS: The expression levels of DLK1 protein in 204 NSCLC tissues were examined by immunohistochemical (IHC) staining, and the correlation between DLK1expression and clinicopathological features was analyzed. Bisulfate sequencing PCR (BSP) of DNA samples from the tumor tissues of 18 NSCLC patients was performed to evaluate the DNA methylation status of CpG island in the DLK1 promoter region, and also compared with the corresponding IHC staining of DLK1 protein in the same samples. RESULTS: Among the 102 squamous cell carcinoma (SCC) tissue specimens and their adjacent normal bronchial epithelia, DLK1 was up-regulated in 72 and 37 samples, respectively (P=0.001), and among 102 adenocarcinomas (ADC) tissues and their adjacent alveolar tissues, DLK1 was up-regulated in 77 and 7 samples, respectively (P<0.001). In addition, overexpression of DLK1 was significantly associated with histological type, clinical stage and tumor size of NSCLC (P<0.05 for all). The expression of DLK1protein was inversely correlated with its promoter methylation (P<0.05). CONCLUSION: DLK1 expression is up-regulated in NSCLCs, which may be due, at least in part, to the DNA hypomethylation in the promoter region of theDLK1 gene.

Pharmacokinetic Analysis of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Distinguishing Hepatocellular Carcinoma From Cholangiocarcinoma in Pre-Liver Transplantation Evaluation.

OBJECTIVE: Liver transplantation for intrahepatic cholangiocarcinoma is notorious for rapid recurrence with poor survival rate postoperatively and has therefore been discontinued in most centers. The purpose of this study is to distinguish hepatocellular carcinoma (HCC) from cholangiocarcinoma in pretransplantation imaging evaluation by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS: From January 2014 to September 2015, 19 patients were included in the study, with a mean age of 62.8 years. All subjects underwent pretransplantation DCE-MRI and surgical excision or core biopsy. The DCE-MRI parameters were measured using the Tofts model 1999. Statistical analysis included nonparametric tests and area under the curve for the receiver operating characteristic. RESULTS: Fourteen HCCs and 5 cholangiocarcinomas were diagnosed by surgical pathology. The mean size of tumor was 6.4 cm (range, 1.5 cm to 13.7 cm). All DCE-MRI parameters were calculated as the ratio between the tumor and normal liver parenchyma and K(trans) (1/min) was used as a distinguishing parameter between the two tumors. K(trans) was higher in the cholangiocarcinoma group (1.89 ± 1.13) than in the HCC group (0.46 ± 0.35). Univariate analysis revealed that K(trans) has a high significant difference (P = .001). The optimal K(trans) value cutoffs were 1 or more (area under the curve = 0.971) for detection of HCCs or cholangiocarcinomas. CONCLUSION: The analysis of DCE-MRI with the kinetic model (Tofts, 1999) presents a new and practical approach indiscrimination of HCC from cholangiocarcinoma for pretransplantation imaging evaluation.

[Relationship between urinary polycyclic aromatic hydrocarbon metabolite and cell cycle of lymphocyte in coke oven workers].

Objective: To investigate the relationship between urinary polycyclic aromatic hydrocarbon metabolite and cell cycle of lymphocyte in coke oven workers. Methods: 437 coke oven workers and 163 work-ers in water treatment department were recruited in this study. Flow cytometry was used to detect the cell cycle of lymphocyte. For the measurement of urinary metabolites, urine samples were treated with ß-glucuronidase and analyzed using HPLC with a fluorescence detector. Results: The concentrations of urinary 2-naphthol, 2-hydroxyfluorene, 9-phenanthrol and 1-hydroxypyrene l in coke oven workers were significantly higher than those in control group (P<0.01) . The distributions of cell cycle were analyzed in high exposure group (the content of urinary metabolites high than P75) and low exposure group (the content of urinary metabolites low than P25) . According to the content of 1-hydroxypyrene, the proportions of S phase in high exposure group were significant-ly higher than those of low exposure group (Z=-2.496, P=0.013) , but the proportions of G0/G1 phase were sig-nificantly lower than low exposure group (Z=-2.074, P=0.038) . The similar results were not been found in other hydroxylated metabolites as internal exposure group. Conclusion: Increasing levels of urinary 1-hydroxypyrene might resulting in cell cycle of lymphocyte disorders, mainly for G0/G1 phase shorten and S phase arrest.

Electro-responsive macroporous polypyrrole scaffolds for triggered dexamethasone delivery.

Corticosteroids such as dexamethasone are first line ophthalmic treatment for non-infectious posterior uveitis. Corticosteroids are often administered via intravitreal injection to treat this condition with frequent injections associated with poor treatment adherence and complications such as endophthalmitis. Current ocular implants provide sustained corticosteroid release at predetermined rates and lack the ability for dose individualisation. This study describes the successful fabrication of electrically responsive macroporous polypyrrole (PPy) thin films, and their subsequent application to triggered dexamethasone release. Colloidal crystal films composed of 370nm polymethylmethacrylate colloids were first deposited on ITO coated glass substrates, and subsequently used as sacrificial templates for the fabrication of high surface area, 3-dimensionally ordered macroporous PPy inverse opal (PPy IO) thin films. SEM, UV-Vis reflectance and cyclic voltammetry measurements established that the redox state of the PPy IO films could be controlled via electrical stimulation, which in turn influences both porosity and optical properties of the films. Incorporation of the anti-inflammatory corticosteroid, dexamethasone phosphate (DexP), in the PPy IO films during their fabrication resulted in an effective delivery platform for triggered DexP release. A sustained release profile was observed for the PPy IO-DexP films, bursts of release could be triggered by electrical stimulation. The amount of DexP released from the PPy IO-DexP films was significantly higher than that released from the conventional non-porous PPy-DexP films of comparable mass. Results suggest that electrically responsive PPy IO structures are highly suitable for on-demand drug delivery applications. This technology may enable physicians to fine-tune the required dose according to disease state and patients' needs to enhance the safety and efficacy of corticosteroid treatment.

GRP78 as a regulator of liver steatosis and cancer progression mediated by loss of the tumor suppressor PTEN.

Glucose-regulated protein 78 (GRP78), a molecular chaperone widely elevated in human cancers, is critical for endoplasmic reticulum (ER) protein folding, stress signaling and PI3K/AKT activation. Genetic knockout models of GRP78 revealed that GRP78 maintains homeostasis of metabolic organs, including liver, pancreas and adipose tissues. Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are the most common liver cancers. There is a lack of effective therapeutics for HCC and CC, highlighting the need to further understand liver tumorigenic mechanisms. PTEN (phosphatase and tenson homolog deleted on chromosome 10), a tumor suppressor that antagonizes the PI3K/AKT pathway, is inactivated in a wide range of tumors, including 40-50% of human liver cancers. To elucidate the role of GRP78 in liver cancer, we created a mouse model with biallelic liver-specific deletion of Pten and Grp78 mediated by Albumin-Cre-recombinase (cP(f/f)78(f/f)). Interestingly, in contrast to PTEN, deletion of GRP78 was progressive but incomplete. At 3 months, cP(f/f)78(f/f) livers showed hepatomegaly, activation of lipogenic genes, exacerbated steatosis and liver injury, implying that GRP78 protects the liver against PTEN-null-mediated pathogenesis. Furthermore, in response to liver injury, we observed increased proliferation and expansion of bile duct and liver progenitor cells in cP(f/f)78(f/f) livers. Strikingly, bile duct cells in cP(f/f)78(f/f) livers maintained wild-type (WT) GRP78 level, whereas adjacent areas showed GRP78 reduction. Analysis of signaling pathways revealed selective JNK activation, ß-catenin downregulation, along with PDGFRα upregulation, which was unique to cP(f/f)78(f/f) livers at 6 months. Development of both HCC and CC was accelerated and was evident in cP(f/f)78(f/f) livers at 8-9 months, coinciding with intense GRP78 expression in the cancer lesions, and GRP78 expression in adjacent normal areas reverted back to the WT level. In contrast, c78(f/f) livers showed no malignancy even at 14 months. These studies reveal that GRP78 is a novel regulator for PTEN-loss-mediated liver injury and cancer progression.

Loss of microRNA-143/145 disturbs cellular growth and apoptosis of human epithelial cancers by impairing the MDM2-p53 feedback loop.

Dysregulated microRNAs (miRNAs) have an important role in many malignant tumors. However, elucidating the roles of miRNAs in cancer biology, especially in epithelial cancers, remains an ongoing process. In this study, we show that both miR-143 and miR-145, which belong to the same miRNA cluster, can negatively modulate expression of their target gene, MDM2. The miR-143 and miR-145 is posttranscriptionally activated by upregulated p53, thereby generating a short miRNAs-MDM2-p53 feedback loop. Re-expression of these miRNAs suppresses cellular growth and triggers the apoptosis of epithelial cancer, in vitro and in vivo, by enhancing p53 activity via MDM2 turnover. Moreover, the miRNA-dependent MDM2 turnover contributes to the equilibrium of repeated p53 pulses in response to DNA damage stress. These findings suggest that MDM2 dysregulation caused by downregulation of miR-143 and miR-145 contributes to epithelial cancer development and has a key role in regulating cellular proliferation and apoptosis. Re-expression of miR-143 and miR-145 may be a reasonable strategy for treatment of epithelial cancers.

Overexpression of miR-370 and downregulation of its novel target TGFß-RII contribute to the progression of gastric carcinoma.

MicroRNAs (miRNAs) are endogenous non-coding RNAs that are known to be involved in the pathogenesis of tumors. Gastric carcinoma (GC) is a common malignancy worldwide. The aim of this study was the identification of the expression signature and functional roles of aberrant miRNAs in GC. Initial screening established a profile of aberrantly expressed miRNAs in tumors. miR-370 was confirmed to be overexpressed in GC tissues. Higher expression of miR-370 in GC tissues was associated with more advanced nodal metastasis and a higher clinical stage compared with controls. In addition, significantly higher level of miR-370 was noted in the plasma of GC patients compared with controls. Patients having more invasive or advanced tumors also exhibited a higher plasma level of miR-370. In vitro assays indicated that exogenous miR-370 expression enhanced the oncogenic potential of GC cells. The AGS-GFPM2 cells with exogenous miR-370 expression also exhibited enhanced abdominal metastatic dissemination in nude mice. Reporter assays confirmed that miR-370 targeted predicted sites in 3'UTR of transforming growth factor-ß receptor II (TGFß-RII) gene. The exogenous miR-370 expression decreased TGFß-RII expression and the phosphorylation of Smad3 elicited by TGFß1. The TGFß1-mediated repression in cell migration was reverted by exogenous miR-370 expression. A reverse correlation between miR-370 and TGFß-RII expression was noted in GC tissues. This study concludes that miR-370 is a miRNA that is associated with GC progression by downregulating TGFß-RII. The miRNA expression profile described in this study should contribute to future studies on the role of miRNAs in GC.

Radiofrequency ablation for hepatocellular carcinoma: use of low vs maximal radiofrequency power.

OBJECTIVES: To investigate whether radiofrequency (RF) ablation with low power (LP) or maximal power (MP) for hepatocellular carcinoma (HCC) can achieve optimal ablation and fewer adverse effects. METHODS: RF ablation was performed with MP in 101 patients (129 tumours) and with LP in 46 patients (61 tumours). MP RF ablation used power of >120 W. RF power below this was designated as LP. Clinical outcomes were also analysed in subgroups of high-risk tumours near the bile duct and blood vessels. RESULTS: Primary effectiveness was achieved in 91.8% in the LP group and 89.9% in the MP group (p = 0.795). 1 and 2-year local tumour progression rates were 28% and 30%, respectively, in the LP group, and 24% and 29%, respectively, in the MP group (p = 0.70). 1 and 2-year survival rates were 98% and 98%, respectively, in the LP group, and 93% and 90%, respectively, in the MP group (p = 0.216). The MP group had more adverse effects, with post-RF ablation syndrome, asymptomatic pleural effusion and ascites, than the LP group (20% vs 39% in the MP group; p = 0.027); however, there was no significant difference in major complication rates (6% in the MP and LP groups; p = 0.497). Among the patients with high-risk tumours, RF ablation using MP vs LP was comparable in primary effectiveness (91.7% vs 95.2%; p = 0.618), local tumour progression (42.9% vs 29.2%; p = 0.304) and overall complications (5% vs 8%; p=0.618). CONCLUSION: RF ablation with LP and MP are comparable in clinical outcomes but considerably fewer adverse effects were encountered in the LP group.

Decreased expression of profilin 2 in oral squamous cell carcinoma and its clinicopathological implications.

Profilins are small proteins essential for many normal cellular dynamics and constitute one of the crucial components of actin-based cellular motility. Several recent studies have implicated a role for the profilin (PFN) family in cancer pathogenesis and progression. However, their expression and promising functions are largely unknown in oral squamous cell carcinoma (OSCC). In this study, we analyzed the correlation between PFN1 and PFN2 expression in vitro and in vivo. The protein expression levels were roughly compared between cell lines (HIOEC, HB96) with the employment of mass spectrometry. PFN2 was singled out as one of the significantly down-regulated genes in the cancerous HB96 cells. The expression levels of PFN1 and PFN2 in vitro were validated by RT-PCR, real-time PCR and Western blotting. Laser scanning confocal microscopy was used for the first time to assess the localization of PFN2 expression. In subsequent experiments, we observed the relationship between PFN2 expression levels and the proliferation of transfected HB96 cancer cells. VASP, N-WASP and P27 expression was also examined in the PFN2-transfected or non-transfected HB96 cells. In vivo, antigen expression was determined by immunohistochemical analyses in 88 paired tissue specimens. Decreased protein expression was confirmed in cancerous tissues from 88 OSCC patients compared with paracancerous normal mucous epithelia. Tumors with weak PFN2 expression were associated with a significantly worse prognosis than strongly expressed tumours (P<0.001). Other statistical analyses were performed to assess the differences in expression and their clinical and pathological significance. In conclusion, PFN2 can be utilized as both a potential suppressor marker and a prognostic protein for OSCC. The function of PFN2 may be to regulate the N-WASP/Arp2/3 signaling pathway.

Are the risk factors listed in warfarin prescribing information associated with anticoagulation-related bleeding? A systematic literature review.

Warfarin significantly reduces thromboembolic risk, but perceptions of associated bleeding risk limit its use. The evidence supporting the association between bleeding and individual patient risks factors is unclear. This systematic review aims to determine the strength of evidence supporting an accentuated bleeding risk when patients with risk factors listed in the warfarin prescribing information are prescribed the drug. A systematic literature search of MEDLINE and Cochrane CENTRAL was conducted to identify studies reporting multivariate relationships between prespecified covariates and the risk of bleeding in patients receiving warfarin. The prespecified covariates were identified based on patient characteristics for bleeding listed in the warfarin package insert. Each covariate was evaluated for its association with specific types of bleeding. The quality of individual evaluations was rated as 'good', 'fair' or 'poor' using methods consistent with those recommended by the Agency for Healthcare Research and Quality (AHRQ). Overall strength of evidence was determined using the Grading of Recommendations Assessment, Development (GRADE) criteria and categorised as 'insufficient', 'very low', 'low', 'moderate' or 'high'. Thirty-four studies, reporting 134 multivariate evaluations of the association between a covariate and bleeding risk were identified. The majority of evaluations had a low strength of evidence for the association between covariates and bleeding and none had a high strength of evidence. Malignancy and renal insufficiency were the only two covariates that had a moderate strength of evidence for their association with major and minor bleeding respectively. The associations between covariates listed in the warfarin prescribing information and increased bleeding risk are not well supported by the medical literature.

Percentage of signal intensity loss for characterisation of focal liver lesions in patients with chronic liver disease using ferucarbotran-enhanced MRI.

The purpose of this study was to determine the percentage of signal intensity loss (PSIL) threshold for the characterisation of focal liver lesions among patients with chronic liver disease. 55 nodules in 49 patients with chronic liver disease who underwent ferucarbotran-enhanced MR studies were included. Among the 49 patients, 40 had liver cirrhosis and 9 had chronic hepatitis. 8 haemangiomas, 3 focal nodular hyperplasia, 9 dysplastic nodules and 12 well, 19 moderately and 4 poorly differentiated hepatocellular carcinomas (HCCs) were revealed. The PSIL, signal-to-noise ratio and contrast-to-noise ratio of each lesion type were calculated. The diagnostic performance of PSIL on ferucarbotran-enhanced T(2) weighted images (PSIL(T2WI)) and T(2) weighted fat-suppression images (PSIL(FS-T2WI)) that characterised hepatic tumours was compared with receiver operating characteristic (ROC) analysis. Using ROC analysis, the diagnostic performance of PSIL(FS-T2WI) was superior to that of PSIL(T2WI) (p = 0.01). The mean PSIL(FS-T2WI) of the benign lesions was significantly higher than that of HCC (p<0.001), and the mean PSIL(FS-T2WI) of well-differentiated HCC was significantly higher than that of moderately/poorly differentiated HCCs (p = 0.001). With a PSIL(FS-T2WI) threshold of 40% in lesions characterising ferucarbotran-enhanced FS-T2WI, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.6%, 95%, 90.9%, 96.9% and 82.6%, respectively. In conclusion, with ferucarbotran-enhanced FS-T2WI, a PSIL(FS-T2WI) threshold of 40% for characterising focal liver nodules among patients with chronic liver disease is recommended. It is useful for distinguishing HCC from benign nodules.