Imaging of Amyloid-Related Imaging Abnormalities (ARIA)
Horst Urbach1, Jennifer Linn2, Elke Hattingen3
1Dept. of Neuroradiology, University Medical Center Freiburg, Germany.
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|November 23, 2023
Summary
Alzheimer's disease patients treated with amyloid-clearing monoclonal antibodies may develop ARIA (amyloid-related imaging abnormalities), including edema or hemorrhages. Management varies, with asymptomatic cases potentially managed by drug discontinuation.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Alzheimer's disease (AD) treatment now includes monoclonal antibodies targeting brain amyloid plaques.
- Amyloid-related imaging abnormalities (ARIA) are a potential side effect of these therapies.
- ARIA presents as edema/effusions (ARIA-E) or microbleeds/hemosiderosis (ARIA-H) on MRI.
Purpose of the Study:
- To describe the occurrence and characteristics of ARIA in patients undergoing amyloid-targeting therapy.
- To compare ARIA imaging findings with cerebral amyloid angiopathy (CAA)-related inflammation (CAA-ri).
- To discuss current management strategies for ARIA.
Main Methods:
- Review of MRI findings in patients treated with amyloid-clearing monoclonal antibodies.
- Comparison of ARIA imaging features with known patterns of CAA-ri.
- Analysis of patient symptoms and outcomes related to ARIA severity.
Main Results:
- ARIA prevalence is dose-dependent, affecting up to 40% of patients.
- Apolipoprotein E4 and CAA increase ARIA risk.
- ARIA imaging findings resemble CAA-ri, with ~20% of ARIA patients exhibiting symptoms.
Conclusions:
- ARIA is a significant consideration in amyloid-targeting therapy for AD.
- Distinguishing ARIA from CAA-ri is crucial for patient management.
- Management strategies, including drug discontinuation, are guided by ARIA severity and patient symptoms.
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