MR imaging features of amyloid-related imaging abnormalities

Jerome Barakos, R. Sperling, S. Salloway, Clifford R Jr. Jack, A. Gass, J. B. Fiebach, D. Tampieri, D. Melançon, Y. Miaux, G. Rippon, R. Black, Y. Lu, H. R. Brashear, H. M. Arrighi, K. A. Morris, M. Grundman

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Abstract

BACKGROUND AND PURPOSE: AD is one of the few leading causes of death without a disease-modifying drug; however, hopeful agents are in various phases of development.MRimaging abnormalities, collectively referredtoas amyloid-related imaging abnormalities,havebeenreported for several agents that target cerebral Aβ burden. ARIA includes ARIA-E, parenchymal or sulcal hyperintensities on FLAIR indicative of parenchymal edema or sulcal effusions, and ARIA-H, hypointense regions on gradient recalled-echo/T2*indicative of hemosiderin deposition. This report describes imaging characteristics of ARIA-E and ARIA-H identified during studies of bapineuzumab, a humanized monoclonal antibody againstAβ. MATERIALS AND METHODS: Two neuroradiologists with knowledge of imaging changes reflective of ARIA reviewed MR imaging scans from 210 bapineuzumab-treated patients derived from 3 phase 2 studies. Each central reader interpreted the studies independently, and discrepancies were resolved by consensus. The inter-reader κ was 0.76, with 94% agreement between neuroradiologists regarding the presence or absence of ARIA-E in individual patients. RESULTS: Thirty-six patients were identified with incident ARIA-E (17.1%, 36/210) and 26 with incident ARIA-H (12.4%, 26/210); of those with incident ARIA-H, 24 had incident microhemorrhages and 2 had incident large superficial hemosiderin deposits. CONCLUSIONS: In 49% of cases of ARIA-E, there was the associated appearance of ARIA-H. In treated patients without ARIA-E, the risk for incident blood products was 4%. This association between ARIA-E and ARIA-H may suggest a common pathophysiologic mechanism. Familiarity with ARIA should permit radiologists and clinicians to recognize and communicate ARIA findings more reliably for optimal patient management.

Original languageEnglish (US)
Pages (from-to)1958-1965
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume34
Issue number10
DOIs
StatePublished - Oct 2013

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Amyloid
Hemosiderin
Antibodies, Monoclonal, Humanized
Cause of Death
Edema
Consensus
Pharmaceutical Preparations
bapineuzumab

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Barakos, J., Sperling, R., Salloway, S., Jack, C. R. J., Gass, A., Fiebach, J. B., ... Grundman, M. (2013). MR imaging features of amyloid-related imaging abnormalities. American Journal of Neuroradiology, 34(10), 1958-1965. https://doi.org/10.3174/ajnr.A3500

MR imaging features of amyloid-related imaging abnormalities. / Barakos, Jerome; Sperling, R.; Salloway, S.; Jack, Clifford R Jr.; Gass, A.; Fiebach, J. B.; Tampieri, D.; Melançon, D.; Miaux, Y.; Rippon, G.; Black, R.; Lu, Y.; Brashear, H. R.; Arrighi, H. M.; Morris, K. A.; Grundman, M.

In: American Journal of Neuroradiology, Vol. 34, No. 10, 10.2013, p. 1958-1965.

Research output: Contribution to journalArticle

Barakos, J, Sperling, R, Salloway, S, Jack, CRJ, Gass, A, Fiebach, JB, Tampieri, D, Melançon, D, Miaux, Y, Rippon, G, Black, R, Lu, Y, Brashear, HR, Arrighi, HM, Morris, KA & Grundman, M 2013, 'MR imaging features of amyloid-related imaging abnormalities', American Journal of Neuroradiology, vol. 34, no. 10, pp. 1958-1965. https://doi.org/10.3174/ajnr.A3500
Barakos J, Sperling R, Salloway S, Jack CRJ, Gass A, Fiebach JB et al. MR imaging features of amyloid-related imaging abnormalities. American Journal of Neuroradiology. 2013 Oct;34(10):1958-1965. https://doi.org/10.3174/ajnr.A3500
Barakos, Jerome ; Sperling, R. ; Salloway, S. ; Jack, Clifford R Jr. ; Gass, A. ; Fiebach, J. B. ; Tampieri, D. ; Melançon, D. ; Miaux, Y. ; Rippon, G. ; Black, R. ; Lu, Y. ; Brashear, H. R. ; Arrighi, H. M. ; Morris, K. A. ; Grundman, M. / MR imaging features of amyloid-related imaging abnormalities. In: American Journal of Neuroradiology. 2013 ; Vol. 34, No. 10. pp. 1958-1965.
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abstract = "BACKGROUND AND PURPOSE: AD is one of the few leading causes of death without a disease-modifying drug; however, hopeful agents are in various phases of development.MRimaging abnormalities, collectively referredtoas amyloid-related imaging abnormalities,havebeenreported for several agents that target cerebral Aβ burden. ARIA includes ARIA-E, parenchymal or sulcal hyperintensities on FLAIR indicative of parenchymal edema or sulcal effusions, and ARIA-H, hypointense regions on gradient recalled-echo/T2*indicative of hemosiderin deposition. This report describes imaging characteristics of ARIA-E and ARIA-H identified during studies of bapineuzumab, a humanized monoclonal antibody againstAβ. MATERIALS AND METHODS: Two neuroradiologists with knowledge of imaging changes reflective of ARIA reviewed MR imaging scans from 210 bapineuzumab-treated patients derived from 3 phase 2 studies. Each central reader interpreted the studies independently, and discrepancies were resolved by consensus. The inter-reader κ was 0.76, with 94{\%} agreement between neuroradiologists regarding the presence or absence of ARIA-E in individual patients. RESULTS: Thirty-six patients were identified with incident ARIA-E (17.1{\%}, 36/210) and 26 with incident ARIA-H (12.4{\%}, 26/210); of those with incident ARIA-H, 24 had incident microhemorrhages and 2 had incident large superficial hemosiderin deposits. CONCLUSIONS: In 49{\%} of cases of ARIA-E, there was the associated appearance of ARIA-H. In treated patients without ARIA-E, the risk for incident blood products was 4{\%}. This association between ARIA-E and ARIA-H may suggest a common pathophysiologic mechanism. Familiarity with ARIA should permit radiologists and clinicians to recognize and communicate ARIA findings more reliably for optimal patient management.",
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AU - Fiebach, J. B.

AU - Tampieri, D.

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