ObjectiveTo explored the accuracy and effectiveness of “swimming pool” sign in recognizing fluid attenuated inversion recovery sequence (FLAIR) compared with traditional methods, and to solve the difficulties in distinguishing T1 weighted image (TIWI) and FLAIR in clinical medical students and junior residents. Methods Using the observational research method, forty standardized training physicians who rotated in the Department of Neurology, West China hospital of Sichuan University were included as the research objects between September and November 2021. Standardized training physicians were randomly divided into “swimming pool” sign group and control group, with 20 persons in each group. In the same period, 100 patients with central nervous system infection, cerebral vascular disease, dementia syndrome, multiple sclerosis and no obvious intracranial lesions were selected from the Department of Neurology, West China Hospital of Sichuan University between September and November 2021. According to the diagnosis, the patients were divided into 5 groups with 20 cases in each group. Two groups were given the same 20 images respectively, including T1WI and FLAIR. Record the accuracy, total time-consuming and time-consuming per image of each standardized training physicians. Results Each patient had “swimming pool” sign. Under different backgrounds, the accuracy of the “swimming pool” sign group was higher than that of the control group (P<0.001), while the total time-consuming and time-consuming per image were lower than that of the control group (P<0.001). Conclusions In different nervous system diseases, “swimming pool” sign is stable on FLAIR. Compared with traditional methods, “swimming pool” sign can quickly and accurately distinguish T1WI and T2 FLAIR.
Objective To explore the correlations of serum levels of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), and their ratios, with the severity of white matter hyperintensities (WMH) in patients with cerebral small vessel disease (CSVD). Methods This prospective study included patients with CSVD who were treated at Zhongshan Hospital, Xiamen University between January 2022 and February 2024. Qualitative and quantitative analyses of WMH were performed using the Fazekas scale and lesion prediction algorithm. Biomarkers such as MMP-2, MMP-9, and TIMP-1 were measured to explore their correlations with the severity of WMH. Results A total of 144 patients with CSVD were included in this study, comprising 63 males and 81 females, with an average age of (67.60±8.73) years. There were 83 (57.6%), 41 (28.5%), and 20 (13.9%) patients were categorized as Fazekas grade 1, 2, and 3 for WMH, respectively, with an median total WMH volume of 4.31 mL. Multinomial logistic regression analysis for Fazekas grade (grade 1 as the reference level) showed that MMP-2 [grade 2: odds ratio (OR)=1.059, 95% confidence interval (CI) (1.016, 1.105); grade 3: OR=1.463, 95%CI (1.124, 1.905)], TIMP-1 [grade 2: OR=1.019, 95%CI (1.006, 1.032); grade 3: OR=1.048, 95%CI (1.008, 1.090)], and MMP-9/TIMP-1 [grade 3: OR=2.650, 95%CI (1.393, 5.039)] were independently associated with Fazekas grade (P<0.05). Multinomial logistic regression analysis for the quartile group of total WMH volume (group Q1 as the reference level) showed that MMP-2 [group Q2: OR=1.160, 95%CI (1.021, 1.318); group Q3: OR=1.238, 95%CI (1.086, 1.412); group Q4: OR=1.313, 95%CI (1.140, 1.512)] and TIMP-1 [group Q2: OR=1.095, 95%CI (1.054, 1.138); group Q3: OR=1.084, 95%CI (1.045, 1.125); group Q4: OR=1.102, 95%CI (1.057, 1.149)] were independently associated with the quartile group of total WMH volume (P<0.05). Conclusions Serum levels of MMP-2 and TIMP-1 demonstrate significant independent associations with both the Fazekas grade and the total volume of WMH in patients with CSVD. These correlations underscore the potential utility of MMP-2 and TIMP-1 as critical biomarkers for assessing the severity of WMH in CSVD, highlighting their prospective roles in clinical diagnostics and therapeutic monitoring.