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

Imaging of Amyloid-Related Imaging Abnormalities (ARIA)

Article in several languages: English | deutsch
1   Dept. of Neuroradiology, University Medical Center Freiburg, Germany
Jennifer Linn
2   Dept. of Neuroradiology, University Medical Center Dresden, Germany
Elke Hattingen
3   Dept. of Neuroradiology, University Medical Center Frankfurt, Germany
Jochen Fiebach
4   CSB-Neuroradiology, Charite University Hospital Berlin, Germany
› Author Affiliations


Patients with Alzheimer’s disease (AD) can now be treated with monoclonal antibodies aiming at clearing amyloid plaques from the brain parenchyma. Weeks after initiation of this drug therapy, patients may develop so-called amyloid-related imaging abnormalities (ARIA) on MRI. ARIA comprise vasogenic edema and leptomeningeal effusions (ARIA-E) as well as microbleeds and superficial hemosiderosis (ARIA-H). The prevalence is drug- and dose-dependent (up to 40 % of patients), the apolipoprotein E4 variant and concomitant cerebral amyloid angiopathy (CAA) increase the risk. With regard to MRI characteristics, ARIA strongly resembles the so-called inflammatory subtype of CAA (CAA-ri). While patients with CAA-ri are typically detected due to symptoms such as headaches, lethargy, confusion, and rarely epileptic seizures, around 20 % of ARIA patients show symptoms. Management of ARIA is not yet clearly established. In asymptomatic patients, discontinuation of the drug might be sufficient.

Key points

  • Amyloid-related imaging abnormalities (ARIA) occur in around 20 % of patients who are treated with monoclonal antibodies against amyloid β.

  • There are 2 types: ARIA-E (edema effusion) und ARIA-H (hemorrhage).

  • Depending on the severity, therapy with monoclonal antibodies is either interrupted or finished.

Citation Format

  • Urbach H, Linn J, Hattingen E et al. Imaging of Amyloid-Related Imaging Abnormalities (ARIA). Fortschr Röntgenstr 2024; 196: 363 – 369

Publication History

Received: 29 May 2023

Accepted: 02 September 2023

Article published online:
23 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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