Validation of an MRI Rating Scale for Amyloid-Related Imaging Abnormalities
Arianne Bechten1, Mike P Wattjes1, Derk D Purcell2,3
1Image Analysis Centre, Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
Introduction:
Immunotherapeutic agents against amyloid beta (Aβ) are associated with adverse events, including amyloid-related imaging abnormalities with edema and effusion (ARIA-E). Recently, a magnetic resonance imaging (MRI) rating scale was developed for ARIA-E detection and classification. The aim of this study was to validate the use of this rating scale in a larger patient group with multiple raters.
Methods:
MRI scans of 75 patients (29 with known ARIA-E and 46 control subjects) were analyzed by five neuroradiologists with different degrees of expertise, according to the ARIA-E rating scale. For each patient, we included a baseline and a follow-up fluid-attenuated inversion recovery image. Interrater agreement was calculated using intraclass correlation coefficient (ICC).
Results:
On average, 4.1% of the ARIA-E cases were missed. We observed a high interrater agreement for scores of sulcal hyperintensity (SH; ICC = .915; 95% CI 85-95) and for the combined scores of the 2 ARIA-E findings, parenchymal hyperintensity (PH) and SH (ICC = .878; 95% CI 79-93). A slightly lower agreement for PH (ICC = .678; 95% CI 51-81) was noted.
Conclusion:
The ARIA-E rating scale is a simple tool to evaluate the extent of ARIA-E in patients recruited into Aβ-lowering therapeutic trials. It shows high interrater agreement among raters with different degrees of expertise.
Insights
A new magnetic resonance imaging (MRI) scale for amyloid-related imaging abnormalities with edema and effusion (ARIA-E) shows high agreement among expert raters. This validated scale aids in assessing ARIA-E in patients undergoing amyloid beta-lowering therapies.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Immunotherapy targeting amyloid beta (Aβ) can cause adverse events like ARIA-E.
- A validated MRI rating scale is needed for ARIA-E detection and classification.
Purpose of the Study:
- To validate a newly developed MRI rating scale for ARIA-E in a larger patient cohort.
- To assess interrater agreement among neuroradiologists with varying expertise.
Main Methods:
- Five neuroradiologists evaluated MRI scans from 75 patients (29 with ARIA-E, 46 controls).
- The ARIA-E rating scale was applied to baseline and follow-up FLAIR images.
- Interrater agreement was quantified using the intraclass correlation coefficient (ICC).
Main Results:
- High interrater agreement was found for sulcal hyperintensity (SH; ICC=.915) and combined ARIA-E scores (ICC=.878).
- Agreement for parenchymal hyperintensity (PH) was slightly lower (ICC=.678).
- An average of 4.1% of ARIA-E cases were missed.
Conclusions:
- The ARIA-E MRI rating scale is a reliable tool for evaluating ARIA-E extent.
- The scale demonstrates high interrater reliability across different levels of expertise.
- This scale supports patient monitoring in Aβ-lowering therapeutic trials.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:27Imaging Studies IV: Magnetic Resonance Imaging