Biomarkers

Area of Science:

• Neurology
• Medical Imaging
• Pharmacology

Background:

• Lecanemab, an FDA-approved Alzheimer's Disease (AD) immunotherapy, requires regular MRI monitoring for amyloid-related imaging abnormalities (ARIA).
• ARIA can manifest as cerebral edema (ARIA-E) or microhemorrhage (ARIA-H), necessitating timely detection.
• Current MRI requirements pose significant logistical and accessibility challenges for patients, caregivers, and healthcare facilities, potentially limiting treatment access.

Purpose of the Study:

• To evaluate the viability of an ultra-low field, portable MRI system for baseline and safety monitoring of patients undergoing lecanemab therapy.
• To compare the diagnostic performance of a portable low-field MRI against standard clinical MRI for detecting ARIA in Alzheimer's Disease patients.

Main Methods:

• 31 patients with AD receiving or having discontinued lecanemab therapy were enrolled.
• Participants underwent MRI scans using a 0.064T Hyperfine Swoop® Portable MR Imaging® system within one week of their clinical MRI.
• Retrospective data analysis included patient age, ARIA history, and reads of both low-field and clinical MRI scans.

Main Results:

• The low-field MRI system achieved 100% sensitivity in detecting mild and moderate ARIA-E.
• The system was not sensitive to ARIA-H (microhemorrhages).
• An incidental subdural hematoma detected on clinical MRI was also identifiable on the low-field MRI.

Conclusions:

• Ultra-low field, portable MRI demonstrates high sensitivity for detecting ARIA-E, a key side effect of lecanemab.
• This technology could serve as an adequate surrogate for standard 1.5/3T clinical MRI scans, potentially alleviating patient and healthcare system burdens.
• Further validation is needed to confirm its role in routine monitoring for lecanemab-treated Alzheimer's patients, particularly for ARIA-H detection.