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.

IF 4.4 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Korean Journal of Radiology Pub Date : 2024-08-01 DOI:10.3348/kjr.2024.0105
So Yeong Jeong, Chong Hyun Suh, Sang Joon Kim, Cynthia Ann Lemere, Jae-Sung Lim, Jae-Hong Lee
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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.

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抗淀粉样β单克隆抗体治疗阿尔茨海默病时代与淀粉样蛋白相关的影像异常:临床和成像特征及核磁共振成像监测的最新进展。
阿尔茨海默病治疗的最新进展主要集中在消除淀粉样蛋白-β(Aβ)斑块上,这是阿尔茨海默病的标志性特征。莱卡奈单抗(lecanemab)和多那奈单抗(donanemab)等单克隆抗体可以通过与不同形式的 Aβ 聚集体结合来改变疾病的进展。然而,这些治疗方法引发了对不良反应的担忧,尤其是淀粉样蛋白相关成像异常(ARIA)。仔细评估安全性,尤其是有关 ARIA 的安全性至关重要。ARIA是由于治疗相关的血管完整性破坏和血管通透性增加,导致蛋白液(ARIA-E)和血红素产物(ARIA-H)渗漏。ARIA-E表示治疗引起的水肿或脑沟渗出,而ARIA-H表示治疗引起的微出血或浅表巩膜沉着。用于 ARIA 评估的最低推荐磁共振成像序列是 T2-FLAIR、T2* 梯度回波(GRE)和弥散加权成像(DWI)。T2-FLAIR 和 T2* GRE 分别是检测 ARIA-E 和 ARIA-H 所必需的。DWI 在区分 ARIA-E 和急性至亚急性梗死方面发挥着作用。包括放射科医生在内的医生必须熟悉 ARIA 的影像学特征、ARIA 检查的适当影像学方案以及临床实践中对检查结果的报告。本综述旨在描述 ARIA 的临床和影像学特征,并提出在临床实践中及时发现和监测 ARIA 的要点。
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来源期刊
Korean Journal of Radiology
Korean Journal of Radiology 医学-核医学
CiteScore
10.60
自引率
12.50%
发文量
141
审稿时长
1.3 months
期刊介绍: The inaugural issue of the Korean J Radiol came out in March 2000. Our journal aims to produce and propagate knowledge on radiologic imaging and related sciences. A unique feature of the articles published in the Journal will be their reflection of global trends in radiology combined with an East-Asian perspective. Geographic differences in disease prevalence will be reflected in the contents of papers, and this will serve to enrich our body of knowledge. World''s outstanding radiologists from many countries are serving as editorial board of our journal.
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