Alzheimer’s treatment is changing. With the introduction of newer anti-amyloid therapies, patients and families have more treatment options to discuss with their physicians—but these therapies also come with important monitoring requirements.
One of the most important is MRI monitoring for Amyloid-Related Imaging Abnormalities, or ARIA.
ARIA can occur in patients receiving certain amyloid-targeting therapies for Alzheimer’s disease. Because many cases may occur without obvious symptoms, MRI gives physicians something symptoms alone cannot: a way to look for specific changes in the brain during treatment.
And when it comes to the brain, “I feel fine” is good news—but it doesn’t always tell the whole story.
What Is ARIA?
Amyloid-Related Imaging Abnormalities (ARIA) are changes that may appear on brain MRI in patients receiving certain anti-amyloid treatments.
ARIA is generally divided into two categories:
ARIA-E (Edema/Effusion)
ARIA-E involves swelling or fluid accumulation in areas of the brain.
ARIA-H (Hemosiderin Deposition)
ARIA-H involves small areas of bleeding, known as microhemorrhages, or deposits of blood-breakdown products along the brain’s surface, known as superficial siderosis.
The Alzheimer’s Association’s ARIA resource notes that appropriate detection and monitoring of ARIA requires established MRI protocols, careful interpretation, and coordination among members of the patient’s care team.
Why Is MRI Monitoring So Important?
One of the challenges with ARIA is surprisingly simple: patients may not know it is happening.
ARIA is often asymptomatic. When symptoms do occur, they may include headache, confusion, dizziness, visual changes, nausea, weakness, difficulty walking or seizures. Rarely, serious or life-threatening complications can occur.
This is why MRI is more than another appointment on the calendar.
MRI allows physicians to evaluate the brain for imaging findings associated with ARIA before treatment and at appropriate points during therapy. If ARIA is identified, the treating physician can use the imaging findings alongside the patient’s symptoms and clinical history to determine the appropriate next steps.
The American College of Radiology (ACR) Appropriateness Criteria specifically identifies noncontrast brain MRI as the appropriate imaging method for post-treatment monitoring of patients receiving anti-amyloid monoclonal antibody therapy and describes MRI sequences used to evaluate ARIA-E and ARIA-H.
ARIA Monitoring Is Not One-Size-Fits-All
The exact MRI schedule depends on the Alzheimer’s medication being used, its current prescribing information, the patient’s individual risk factors and the treating physician’s recommendations.
For example, the FDA updated its recommendations for patients receiving Leqembi® (lecanemab) to include an additional earlier MRI between the second and third infusions, in addition to other scheduled monitoring MRIs. The FDA explained that earlier imaging can help identify ARIA-E sooner and provide information that can guide treatment decisions.
Other amyloid-targeting therapies have their own monitoring requirements. For example, the FDA-approved prescribing information and clinical resources for Kisunla® (donanemab) also address ARIA risk and MRI monitoring.
That is why patients should follow the MRI schedule provided by their neurologist or treating physician rather than relying on a general schedule found online.
Google is useful for many things. Your personal ARIA monitoring schedule probably shouldn’t be one of them.
What Does an ARIA MRI Look For?
An ARIA monitoring MRI is designed to give the care team detailed information about changes that may be associated with treatment.
Radiologists evaluate the images for findings associated with ARIA-E and ARIA-H, including swelling, fluid changes, microhemorrhages and superficial siderosis.
Importantly, MRI can reveal changes even when a patient is not experiencing noticeable symptoms.
This makes imaging an important part of the larger treatment pathway—not because MRI treats ARIA, but because it provides information the treating physician can use when evaluating how to proceed with therapy.
Baseline MRI: Creating a Starting Point
MRI monitoring may begin before the first treatment is administered.
A baseline brain MRI gives the treating physician and radiologist an initial picture of the brain before therapy begins. It can help identify pre-existing findings and provide a reference point for comparison with future scans.
For patients receiving amyloid-targeting therapies, this comparison can be particularly important when evaluating whether new imaging findings have appeared during treatment.
The goal is not simply to collect more scans. It is to make each scan meaningful in the context of the patient’s treatment journey.
What Happens If ARIA Is Found?
Finding ARIA does not automatically mean the same thing for every patient.
Management depends on several factors, including the type of ARIA, its severity, whether symptoms are present and the specific medication the patient is receiving.
Depending on those factors and the medication’s prescribing information, a treating physician may recommend additional MRI monitoring, temporarily holding treatment, or other changes to the treatment plan.
Patients experiencing new neurological symptoms during anti-amyloid treatment should contact their healthcare provider promptly. Symptoms such as significant headache, confusion, vision changes, weakness, difficulty walking or seizures may require urgent medical evaluation.
ARIA MRI Monitoring at Excel Diagnostics & Nuclear Oncology Center
For patients undergoing certain Alzheimer’s treatments, coordinating the right imaging at the right time is an important part of care.
At Excel Diagnostics & Nuclear Oncology Center in Houston, our imaging team provides specialized MRI services to support physicians and patients throughout the Alzheimer’s treatment and monitoring process.
Our goal is straightforward: provide high-quality imaging, careful attention to appropriate imaging protocols, and a patient-centered experience so referring physicians receive the information they need to help manage their patients’ care.
We understand that patients undergoing Alzheimer’s treatment—and the family members supporting them—may already be managing numerous appointments, medications and questions. An MRI appointment should not add unnecessary confusion.
Our team works to make the imaging portion of that journey as clear and comfortable as possible.
Need ARIA MRI Monitoring in Houston?
If your neurologist or healthcare provider has ordered a baseline or follow-up MRI for ARIA monitoring, Excel Diagnostics & Nuclear Oncology Center can help coordinate your imaging appointment.
Patients, caregivers and referring providers can contact Excel to learn more about ARIA MRI monitoring, scheduling and referral requirements.
Excel Diagnostics & Nuclear Oncology Center
Houston, Texas
This article is provided for educational purposes only and is not a substitute for medical advice. MRI schedules and treatment decisions should be determined by the prescribing or treating healthcare professional based on the specific medication, current prescribing information and individual patient circumstances.