Altered Clearance and Amyloid-Related Imaging Abnormalities

Petrice M Cogswell; Brian J Burkett; Derek R Johnson; Jay J Pillai

doi:10.1016/j.nic.2024.12.002

Altered Clearance and Amyloid-Related Imaging Abnormalities

Neuroimaging Clin N Am. 2025 May;35(2):267-275. doi: 10.1016/j.nic.2024.12.002. Epub 2025 Feb 19.

Authors

Petrice M Cogswell¹, Brian J Burkett², Derek R Johnson², Jay J Pillai²

Affiliations

¹ Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: Cogswell.petrice@mayo.edu.
² Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

PMID: 40210382
DOI: 10.1016/j.nic.2024.12.002

Abstract

Amyloid-related imaging abnormalities (ARIA) are parenchymal edema/effusion and hemorrhage that occur as side effects of immunotherapies targeting beta-amyloid for patients with Alzheimer's disease (AD). The mechanism of ARIA remains unclear but is thought to be due to loss of vascular integrity secondary to overwhelming perivascular clearance pathways, worsening of cerebral amyloid angiopathy (CAA), removal of amyloid from the vessel wall, and initiation of a local immune response. Further imaging and neuropathological studies may help further inform the mechanism of ARIA and its relationship to underlying AD and CAA pathology.

Keywords: Alzheimer’s disease; Amyloid-related imaging abnormalities (ARIA); Anti-amyloid immunotherapies; Cerebral amyloid angiopathy; Perivascular drainage pathways.

Publication types

Review

MeSH terms

Alzheimer Disease* / diagnostic imaging
Alzheimer Disease* / metabolism
Amyloid beta-Peptides* / metabolism
Brain / diagnostic imaging
Brain / metabolism
Cerebral Amyloid Angiopathy* / diagnostic imaging
Humans
Neuroimaging* / methods

Substances

Amyloid beta-Peptides