Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Amyloid-Related Imaging Abnormalities in the Era of Anti-Amyloid Beta Monoclonal Antibodies for Alzheimer's Disease: Recent Updates on Clinical and Imaging Features and MRI Monitoring

  • So Yeong Jeong (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chong Hyun Suh (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Joon Kim (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cynthia Ann Lemere (Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School) ;
  • Jae-Sung Lim (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae-Hong Lee (Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2024.01.29
  • Accepted : 2024.05.22
  • Published : 2024.08.01
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Abstract

Recent advancements in Alzheimer's disease treatment have focused on the elimination of amyloid-beta (Aβ) plaque, a hallmark of the disease. Monoclonal antibodies such as lecanemab and donanemab can alter disease progression by binding to different forms of Aβ aggregates. However, these treatments raise concerns about adverse effects, particularly amyloid-related imaging abnormalities (ARIA). Careful assessment of safety, especially regarding ARIA, is crucial. ARIA results from treatment-related disruption of vascular integrity and increased vascular permeability, leading to the leakage of proteinaceous fluid (ARIA-E) and heme products (ARIA-H). ARIA-E indicates treatment-induced edema or sulcal effusion, while ARIA-H indicates treatment-induced microhemorrhage or superficial siderosis. The minimum recommended magnetic resonance imaging sequences for ARIA assessment are T2-FLAIR, T2* gradient echo (GRE), and diffusion-weighted imaging (DWI). T2-FLAIR and T2* GRE are necessary to detect ARIA-E and ARIA-H, respectively. DWI plays a role in differentiating ARIA-E from acute to subacute infarcts. Physicians, including radiologists, must be familiar with the imaging features of ARIA, the appropriate imaging protocol for the ARIA workup, and the reporting of findings in clinical practice. This review aims to describe the clinical and imaging features of ARIA and suggest points for the timely detection and monitoring of ARIA in clinical practice.

Keywords

Acknowledgement

This work was supported by the National Research Foundation of Korea (NRF-2021R1C1C1014413 to Chong Hyun Suh). This research was supported by a grant of the National Research Foundation of Korea (NRF-2021R1C1C1014413) and a grant of the Korea Dementia Research Project through the Korea Dementia Research Center (KDRC), funded by the Ministry of Health & Welfare and Ministry of Science & ICT, Republic of Korea (RS-2024-00344521).

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