title: An MRI rating scale for amyloid-related imaging abnormalities with edema or effusion.
abstract: OBJECTIVE
  Immune therapy against amyloid-β appears to be a promising target in Alzheimer disease. However, a dose-related risk for ARIA on FLAIR images thought to represent parenchymal vasogenic edema or sulcal effusion (termed "ARIA-E"), has been observed in clinical trials. To assess the intensity of ARIA-E presentation, an MR imaging scale that is both reproducible and easily implemented would assist in monitoring and evaluating this adverse event.
  
  
  METHODS
  On the basis of a review of existing cases from a phase II bapineuzumab study, a scale was constructed with a 6-point score for the 6 regions on each side of the brain (range, 0-60). Scores would be obtained for both parenchymal and sulcal hyperintensities and frequently co-occurring gyral swelling. Inter-rater reliability between 2 neuroradiologists was evaluated in 20 patients, 10 with known ARIA-E and 10 without, by using the intraclass correlation coefficient.
  
  
  RESULTS
  The 2 raters had excellent agreement in the identification of ARIA-E cases. A high inter-rater agreement was observed for scores of parenchymal hyperintensity (ICC = 0.83; 95% CI, 48-96) and sulcal hyperintensity (ICC = 0.89; 95% CI, 63-97) and for the combined scores of the 2 ARIA-E findings (ICC = 0.89; 95% CI, 62-97). Gyral swelling scores were observed to have lower inter-rater agreement (ICC = 0.54; 95% CI, -0.06-0.86).
  
  
  CONCLUSIONS
  The proposed rating scale provides a reliable and easily implemented instrument to grade ARIA-E imaging findings. We currently do not recommend including swelling.
authors: Image Analysis Centre, Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands. f.barkhof@vumc.nl
authors: F
authors: F
authors: Barkhof
authors: M
authors: M
authors: Daams
authors: P
authors: P
authors: Scheltens
authors: H R
authors: HR
authors: Brashear
authors: H M
authors: HM
authors: Arrighi
authors: A
authors: A
authors: Bechten
authors: K
authors: K
authors: Morris
authors: M
authors: M
authors: McGovern
authors: M P
authors: MP
authors: Wattjes
mesh_terms: D000368:Aged; D000465:Algorithms; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001929:Brain Edema / Q000139:chemically induced* / Q000473:pathology*; D016657:Cerebral Amyloid Angiopathy / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013353:Subdural Effusion / Q000139:chemically induced* / Q000473:pathology*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C545458:bapineuzumab