SWI versus T2*GRE for ARIA-H monitoring: a pragmatic perspective on adoption in clinical practice

Résumé fourni par la source

Although radiological severity thresholds for amyloid-related imaging abnormalities with hemosiderin deposition (ARIA-H) were developed using 2-dimensional acquisitions of T2*-weighted gradient-recalled echo (T2*GRE) MRI in pivotal anti-amyloid trials, adoption of well established 3D susceptibility-weighted imaging (SWI) in ARIA-H monitoring in clinical practice represents a reasonable long-term direction for clinical practice. SWI provides documented higher sensitivity and comparable or superior inter-rater reliability compared with conventional T2*GRE for detecting cerebral microbleeds and cortical superficial siderosis, the two key imaging manifestations of ARIA-H. Moreover, SWI is already incorporated into most contemporary dementia MRI protocols, offering important practical and logistical advantages. Available preliminary evidence suggests that the downstream clinical impact of detecting a few additional microbleeds or areas of siderosis may remain modest for most patients. Earlier and more reliable detection could potentially enhance safety by identifying individuals at higher risk of ARIA-H before treatment initiation. The critical requirements are transparency regarding sequence choice and consistency within individual patients over time.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.