Monitoring of amyloid related imaging abnormalities: SWI vs T2*-GRE - 19/06/25

Doi : 10.1016/j.tjpad.2025.100220

Diana M. Sima ^a,^⁎ , Thanh Vân Phan ^a, Ana M. Franceschi ^b, Wende N. Gibbs ^c, Frederik Barkhof ^d,^e,^f,^g, Philip Scheltens ^h,^i,^j, Stephen Salloway ^k, Jeffrey Cummings ^l, Wim Van Hecke ^a, Dirk Smeets ^a
^a icometrix, Leuven, Belgium
^b Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA
^c Department of Radiology, Barrow Neurological Institute, Phoenix, AZ, USA
^d Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
^e Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
^f Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, Netherlands
^g Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK
^h Alzheimer Center Amsterdam, Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
ⁱ Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands
^j EQT Life Sciences, Amsterdam, the Netherlands
^k Butler Hospital, Memory and Aging Program, and Warren Alpert Medical School of Brown University, Providence, RI, USA
^l Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA

^⁎Corresponding author.

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Abstract

Amyloid-β–directed monoclonal antibody therapies may lead to amyloid-related imaging abnormalities (ARIA). Clinical trials that formed the basis for the ARIA radiographic severity grading scale adopted by the approved drugs’ labels utilized T2* gradient recalled echo (T2*-GRE) images for ARIA-hemorrhagic (ARIA-H) assessment. Little is known about the application of susceptibility-weighted imaging (SWI) to ARIA-H assessment. We exploited comparative studies on the usage of SWI instead of 2D T2*-GRE and simulated the impact of SWI’s higher sensitivity on the derived ARIA-H severity distribution for three approved drugs. The simulations indicated that the two sequences are not equivalent when grading ARIA-H severity and that the rate of therapy discontinuation would increase by more than 50% compared to the rates reported in the drugs’ prescribing information. This should be taken into consideration whenever SWI is applied for ARIA safety monitoring. Appropriate imaging guidelines are needed to enhance management of amyloid-β-directed antibody therapies.

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Keywords : Amyloid-related imaging abnormalities (hemorrhagic) (ARIA(-H)), Cerebral microbleeds (CMB), Superficial siderosis, T2*-gradient recalled echo (T2*-GRE), Susceptibility weighted imaging (SWI)