Amyloid-related Imaging Abnormalities (ARIA): Neuroradiologic Findings in Alzheimer’s Disease Patients Treated with Investigational Anti-Amyloid Therapy

Scientific Assembly and Annual Meeting of the Radiological Society of North America 2020

Welcome and Introduction

Panel chair Jerome Barakos, MD, explains the importance of understanding and detecting amyloid-related imaging abnormalities (ARIA) in clinical trials and potentially in clinical practice if an anti-amyloid therapy becomes available, before proceeding to introduce the symposium topics, objectives, and expert panelists.

An Introduction to the Alzheimer’s Disease Landscape
Stephen Salloway, MD, MS, discusses the epidemiology and clinical presentation of Alzheimer’s disease. He describes the current treatments for Alzheimer’s disease and explains the reasons to move towards disease modification, highlighting the rationale for targeting amyloid beta (Aβ). He concludes by introducing ARIA as an adverse event of anti-amyloid therapy, elucidating the hypothesized underlying mechanisms that cause transient ARIA events.

Amyloid-related Imaging Abnormalities: Radiological Presentation, Risk Factors, and Key Considerations for Detection
Jerome Barakos, MD, examines the neuroradiologic findings of amyloid-related imaging abnormalities due to vasogenic edema (ARIA-E) and due to micro-hemorrhages (ARIA-H). He discusses how to differentiate these events from other pathologies that have similar radiological presentation including posterior reversible encephalopathy syndrome (PRES), cerebral amyloid angiopathy-related inflammation (CAA ri), and stroke. Dr. Barakos then presents important data from clinical trials, such as risk factors, timing, and management steps of ARIA.

Case Study Panel Discussion
Erik Gaensler, MD, frames the case study panel discussion by exploring the optimal magnetic resonance imaging sequences and monitoring protocols for ARIA. The expert panel proceed by considering a case of mild ARIA-E that could be misdiagnosed as subarachnoid hemorrhage or an infection such as meningitis. The second case study explores the outcomes of dosing through mild ARIA-E, which progresses to moderate ARIA-E before finally resolving. Finally, the experts explore a case of severe ARIA-E that has an uncommon presentation, as it is detected late, rather than early, in the treatment course.

Key Learning Objectives for Biogen’s RSNA 2020 Symposium:

  • Raise awareness of the imaging and clinical presentation of ARIA among radiologists and clinicians 
  • Review the hypothesized pathophysiology, incidence, and resolution of ARIA from clinical studies of anti-amyloid therapies 
  • Assess pertinent case studies to discuss the key imaging characteristics, differential diagnoses, and optimal detection and management of ARIA

Disclosure: All panelists received honoraria from Biogen for participation in this symposium.

Disclaimer: All of the information discussed today is for informational purposes only; does not constitute medical advice; and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment.