ARIA Evaluation: physiological hallmarks of vascular alterations in patients undergoing anti-amyloid therapy

Motivation: Lecanemab treatment in patients with early Alzheimer's disease (AD) may compromise vascular integrity, potentially leading to amyloid-related imaging abnormalities (ARIA), a common side effect associated with anti-amyloid therapies. Goal(s): To monitor vascular changes in ARIA, including blood-brain barrier (BBB) permeability and cerebral venous oxygenation (Yv), using non-contrast MRI. Approach: BBB permeability and Yv were compared between PET-confirmed amyloid-positive patients treated with Lecanemab and age-matched untreated controls, as well as across two visits for treated patient. Results: BBB permeability increased and Yv decreased in the second versus first scan for Lecanemab-treated patients. However, no significant differences were observed between treated and untreated subjects. Impact: Advanced MRI techniques for assessing BBB permeability and venous oxygenation offer a quantitative approach in detecting early vascular and metabolic changes linked to anti-amyloid treatment, providing valuable insights and tools for monitoring amyloid-related imaging abnormalities (ARIA) and assessing ARIA risk.