MRI Pitfalls in Amyloid-Related Imaging Abnormalities on Anti-Amyloid Therapy

Radiologists reading MRI for anti-amyloid Alzheimer therapy should recognize gray-zone amyloid-related imaging abnormality (ARIA) findings—subtle FLAIR signal, microhemorrhages, overlapping edema/hemorrhage—and technical pitfalls to avoid treatment-affecting misclassification.

• Baseline screening and longitudinal ARIA surveillance often produce borderline findings that do not clearly conform to trial-defined criteria, including subtle or artifactual FLAIR signal abnormality, equivocal microhemorrhage counts, and overlapping ARIA-E and ARIA-H features.
• Practical recommendations include recognizing technical factors affecting susceptibility-weighted and FLAIR interpretation, managing variability in lesion detection across serial examinations, and accurately reporting temporal evolution of ARIA-related findings.
• Improved recognition of these pitfalls may increase diagnostic confidence and avoid misclassification that could influence therapeutic decisions.

Automated summary

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