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Review
. 2025 May;35(2):267-275.
doi: 10.1016/j.nic.2024.12.002. Epub 2025 Feb 19.

Altered Clearance and Amyloid-Related Imaging Abnormalities

Petrice M Cogswell  1 , Brian J Burkett  2 , Derek R Johnson  2 , Jay J Pillai  2
Affiliations
Review

Altered Clearance and Amyloid-Related Imaging Abnormalities

Petrice M Cogswell et al. Neuroimaging Clin N Am. 2025 May.

Abstract

Amyloid-related imaging abnormalities (ARIA) are parenchymal edema/effusion and hemorrhage that occur as side effects of immunotherapies targeting beta-amyloid for patients with Alzheimer's disease (AD). The mechanism of ARIA remains unclear but is thought to be due to loss of vascular integrity secondary to overwhelming perivascular clearance pathways, worsening of cerebral amyloid angiopathy (CAA), removal of amyloid from the vessel wall, and initiation of a local immune response. Further imaging and neuropathological studies may help further inform the mechanism of ARIA and its relationship to underlying AD and CAA pathology.

Keywords: Alzheimer’s disease; Amyloid-related imaging abnormalities (ARIA); Anti-amyloid immunotherapies; Cerebral amyloid angiopathy; Perivascular drainage pathways.

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Conflict of interest statement

Disclosure P.M. Cogswell has participated in medical education sponsored by Lilly, United States, Eisai, Japan, and Kaplan. D.R. Johnson has served on advisory boards for Telix, Novartis, and Cellectar. B.J. Burkett and J.J. Pillai have no disclosures.

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