Are we ready for amyloid-related imaging abnormalities (ARIA) monitoring? A European survey among neuroradiologists and neurologists by the ESNR/EAN Working Group

Abstract

Objectives: Amyloid-lowering immunotherapies can cause amyloid-related imaging abnormalities (ARIA), requiring brain MRI for detection and monitoring. The European Society of Neuroradiology (ESNR)/European Academy of Neurology (EAN) ARIA Working Group conducted a survey to assess European clinicians’ readiness for this logistical challenge and need for further education on ARIA. Materials and methods: An online questionnaire with 32 items (multiple choice, single best choice, and free text) was distributed to ESNR and EAN members. Between June and July 2024, we collected 422 responses from 41 European countries, including 47% neurologists and 51% (neuro)radiologists; 15% were residents, and 58% worked in academic hospitals. Results: Of respondents, 69% were familiar with the concept of ARIA, and 60% reportedly understood its risk factors. Confidence in evaluating ARIA-E (edema/effusion) and ARIA-H (hemorrhage) subtypes was reported by 60% and 69%, respectively, with (neuro)radiologists more confident than neurologists. However, 34% of respondents felt poorly equipped to meet logistical demands, and 82% lacked a dedicated ARIA imaging protocol. Key barriers included limited organizational adaptability and radiology expertise. Notably, 72% saw potential in having support by artificial intelligence approaches, and 93% expressed the wish for further training on how to monitor ARIA. Conclusions: Despite the current unavailability of amyloid-lowering therapies, European neurologists and (neuro)radiologists report reasonable ARIA awareness. There is a clear need for additional practical preparation and training in ARIA assessment, which can inform future ESNR/EAN educational initiatives. Key Points: Question Are neurologists and neuroradiologists ready for ARIA monitoring? Findings Neurologists and neuroradiologists were moderately familiar with the concept of ARIA, its risk factors, and its identification on MRI, but felt poorly equipped to meet the logistical demands. Clinical relevance With the potential introduction of amyloid-lowering therapies in European countries, identifying key barriers, such as limited organizational adaptability and radiology expertise, highlights the need for further practical preparation by clinical departments and additional training in ARIA assessment.