Review outlines pitfalls in MRI detection of amyloid drug side effects

This imaging-focused review examines interpretive challenges encountered in a high-volume anti-amyloid monoclonal antibody therapy program when assessing baseline MRI and monitoring for amyloid-related imaging abnormalities (ARIA). The authors describe borderline or ambiguous findings, such as subtle FLAIR signal changes, equivocal microhemorrhage counts, and overlapping ARIA-E and ARIA-H features, that do not clearly fit trial-defined criteria and can create uncertainty affecting treatment decisions. The review also addresses technical factors affecting susceptibility-weighted and FLAIR image interpretation and variability in lesion detection across serial scans, stating that recognizing these pitfalls can improve diagnostic confidence and help avoid misclassification.

Most relevant for: Radiologists and clinicians involved in baseline MRI screening and longitudinal monitoring of patients receiving anti-amyloid monoclonal antibody therapy for early symptomatic Alzheimer disease.

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