Balancing Speed and Sensitivity: Echo-Planar Accelerated MRI for ARIA-H Screening in Anti-Aβ Therapeutics

The recent advent of anti-amyloid-β monoclonal antibodies has introduced new demands for MRI-based screening of amyloid-related imaging abnormalities, particularly the hemorrhage subtype (ARIA-H). In this editorial, we discuss the study by Loftus and colleagues, which evaluates the diagnostic performance of echo-planar accelerated gradient-recalled echo (GRE) and susceptibility-weighted imaging (SWI) sequences for ARIA-H screening. Their results demonstrate that significant scan time reductions-up to 86%-can be achieved without substantial loss in diagnostic accuracy, particularly for accelerated GRE. These findings align with recently issued MRI guidelines and offer practical solutions for improving workflow efficiency in Alzheimer's care. However, challenges remain in terms of inter-rater variability and image quality, especially with accelerated SWI. We also highlight the emerging role of artificial intelligence-assisted analysis and the importance of reproducibility and data sharing in advancing clinical implementation. Balancing speed and sensitivity remains a central theme in optimizing imaging strategies for antiamyloid therapeutic protocols.