Validation of an MRI Rating Scale for Amyloid-Related Imaging Abnormalities

Arianne Bechten, Mike P. Wattjes, Derk D. Purcell, Esther Sanchez Aliaga, Marita Daams, H. Robert Brashear, H. Michael Arrighi, Frederik Barkhof

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INTRODUCTION: Immunotherapeutic agents against amyloid beta (Aβ) are associated with adverse events, including amyloid-related imaging abnormalities with edema and effusion (ARIA-E). Recently, a magnetic resonance imaging (MRI) rating scale was developed for ARIA-E detection and classification. The aim of this study was to validate the use of this rating scale in a larger patient group with multiple raters. METHODS: MRI scans of 75 patients (29 with known ARIA-E and 46 control subjects) were analyzed by five neuroradiologists with different degrees of expertise, according to the ARIA-E rating scale. For each patient, we included a baseline and a follow-up fluid-attenuated inversion recovery image. Interrater agreement was calculated using intraclass correlation coefficient (ICC). RESULTS: On average, 4.1% of the ARIA-E cases were missed. We observed a high interrater agreement for scores of sulcal hyperintensity (SH; ICC =.915; 95% CI 85–95) and for the combined scores of the 2 ARIA-E findings, parenchymal hyperintensity (PH) and SH (ICC =.878; 95% CI 79–93). A slightly lower agreement for PH (ICC =.678; 95% CI 51–81) was noted. CONCLUSION: The ARIA-E rating scale is a simple tool to evaluate the extent of ARIA-E in patients recruited into Aβ-lowering therapeutic trials. It shows high interrater agreement among raters with different degrees of expertise.

Original languageEnglish
Pages (from-to)318-325
Number of pages8
JournalJournal of neuroimaging
Issue number3
Publication statusPublished - 1 May 2017


  • ARIA (amyloid-related imaging abnormalities)
  • Alzheimer's disease (AD)
  • MRI (magnetic resonance imaging)
  • amyloid beta (Aβ)
  • immunotherapy

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