Imaging of Amyloid-Related Imaging Abnormalities (ARIA)

Horst Urbach; Jennifer Linn; Elke Hattingen; Jochen Fiebach

doi:10.1055/a-2185-8472

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2024; 196(04): 363-369
DOI: 10.1055/a-2185-8472

Review

Bildgebung von Amyloid-related Imaging Abnormalities (ARIA)

Article in several languages: English | deutsch

Authors

Horst Urbach

¹Dept. of Neuroradiology, University Medical Center Freiburg, Germany
Jennifer Linn

²Dept. of Neuroradiology, University Medical Center Dresden, Germany
Elke Hattingen

³Dept. of Neuroradiology, University Medical Center Frankfurt, Germany
Jochen Fiebach

⁴CSB-Neuroradiology, Charite University Hospital Berlin, Germany

Abstract

Zusammenfassung

Bei mittlerweile zugelassenen Therapien der Alzheimer-Erkrankung mit monoklonalen Antikörpern, die Amyloid aus dem Hirnparenchym „herauswaschen“ sollen, kann es zu Veränderungen in der MRT-Bildgebung kommen. Diese Veränderungen werden unter dem Begriff Amyloid-related Imaging abnormalities (ARIA) zusammengefasst. Es handelt sich um vasogene Ödeme und leptomeningeale Effusionen (ARIA-E) sowie Mikroblutungen und superfizielle Hämosiderosen (ARIA-H). Das Auftreten ist Medikamenten- und dosisabhängig (bis 40 % der Patienten), die Apolipoprotein E 4-Variante und eine zerebrale Amyloid-Angiopathie (CAA) als Komorbidität erhöhen das Risiko. In der Bildgebung sind ARIA und die sog. inflammatorische, möglicherweise autoimmunologisch verursachte CAAri (CAA-related inflammation CAA-ri) nicht unterscheidbar. Patienten mit CAA-ri werden in der Regel aufgrund von Symptomen (Kopfschmerzen, Lethargie, Verwirrung, seltener epileptische Anfälle auffällig, ARIA-Patienten sind in etwa 20 % der Fälle symptomatisch. Das weitere Vorgehen bei Nachweis von ARIA ist noch unklar, zunächst wird häufig lediglich das Medikament abgesetzt.

Kernaussagen

Amyloid-related imaging abnormalities (ARIA) treten in ca. 20 % der Patienten auf, die mit gegen Amyloid β gerichteten monoklonalen Antikörpern behandelt werden.
Es werden ARIA-E (edema effusion) und ARIA-H (hemorrhage) unterschieden.
In Anhängigkeit vom Schweregrad wird die Therapie pausiert oder abgebrochen.

Zitierweise

Urbach H, Linn J, Hattingen E et al. Imaging of Amyloid-Related Imaging Abnormalities (ARIA). Fortschr Röntgenstr 2024; 196: 363 – 370

Keywords

MR-imaging - Alzheimer disease - dementia

Full Text

References

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