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Congress: ECR25
Poster Number: C-22122
Type: Poster: EPOS Radiologist (educational)
Authorblock: C. Mbongo, M. R. López De La Torre Carretero, P. Dominguez Echavarri; Pamplona/ES
Disclosures:
Carmen Mbongo: Nothing to disclose
Manuel Rafael López De La Torre Carretero: Nothing to disclose
Pablo Dominguez Echavarri: Nothing to disclose
Keywords: CNS, Neuroradiology brain, Vascular, MR, Audit and standards, Experimental investigations, Treatment effects, Haemorrhage, Inflammation, Monoclonal antibodies
Learning objectives 1. Explain the pathophysiology of ARIA in the context of Alzheimer’s disease and provide a brief overview of monoclonal antibodies used in its treatment.2. Understand the key radiological manifestations of amyloid-related imaging abnormalities (ARIA) associated with anti-amyloid therapies.3. Identify imaging patterns indicative of ARIA to enable early diagnosis and guide effective management.
Read more Background Amyloid-related imaging abnormalities (ARIA) represent a spectrum of MRI findings observed in patients receiving monoclonal antibodies targeting amyloid-beta (Aβ) for Alzheimer's disease (AD). AD is characterized by the accumulation of Aβ plaques and neurofibrillary tangles of hyperphosphorylated tau protein, leading to synaptic dysfunction, neurodegeneration, and progressive cognitive decline. Frequently associated with AD, cerebral amyloid angiopathy (CAA) results from the deposition of Aβ within blood vessels, contributing to vascular fragility and playing a central role in the development of ARIA [1]....
Read more Findings and procedure details NEUROIMAGING FINDINGSARIA consists of two primary classes of MRI signal abnormalities: ARIA-E (edema/effusion) and ARIA-H (hemorrhage), each with distinct imaging features that are crucial for accurate diagnosis and informed clinical decisions. Anti-Aβ therapy exacerbates the vulnerability of vessels affected by preexisting amyloid pathology, leading to vascular extravasation events. This vascular vulnerability is particularly pronounced in carriers of the ApoE4 allele, who exhibit increased amyloid deposition and reduced perivascular clearance [1,3]. The disruption of the blood-brain barrier during Aβ clearance mirrors inflammatory...
Read more Conclusion Early identification of ARIA through MRI is essential for the safe administration of anti-amyloid monoclonal antibodies. While many ARIA cases are asymptomatic, radiological findings can precede severe neurological complications, highlighting the need for ongoing radiological surveillance. This poster provides radiologists with some critical insights for identifying and monitoring ARIA, to optimize patient care and prevent adverse clinical outcomes. As of February 2025, anti-amyloid β monoclonal antibodies are not yet approved for routine clinical use in Europe and are administered exclusively within...
Read more References 1. Agarwal A, Gupta V, Brahmbhatt P, Desai A, Vibhute P, Joseph-Mathurin N, et al. Amyloid-related imaging abnormalities in Alzheimer disease treated with anti–amyloid-β RadioGraphics. 2023;43(9):e230205. doi:10.1148/rg.230205 2. Cogswell PM, Barakos JA, Barkhof F, Benzinger TS, Jack CR Jr, Poussaint TY, et al. Amyloid-related imaging abnormalities with emerging Alzheimer disease therapeutics: Detection and reporting recommendations for clinical practice. AJNR Am J Neuroradiol. 2022;43(9):E19–E35. doi:10.3174/ajnr.A7586. 3. Hampel H, Elhage A, Cho M, Apostolova LG, Nicoll JAR, Atri A. Amyloid-related imaging abnormalities: Radiological, biological...
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