Abstract Details

Title A Retrospective Study of Urgent MRIs for Detection of ARIA in Lecanemab-treated Patients

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 12-005

Objective To characterize the efficiency and use of urgent MRIs for detecting new or worsening amyloid-related imaging abnormalities (ARIA) in patients receiving lecanemab at a multi-campus academic medical center.

Background ARIA is an adverse event of amyloid-targeting immunotherapies. Symptoms are often nonspecific and overlap with non-ARIA pathologies. Early ARIA detection is critical as it can prompt changes in monitoring and treatment.

Design/Methods A chart review was conducted for all patients (n=530) who received at least one lecanemab infusion from December 2023 to September 2025. An urgent brain MRI was defined as an MRI ordered outside the standard monitoring window (as outlined within lecanemab’s FDA label), or a repeat scan within the standard monitoring window due to new or worsening symptoms after a prior negative scan. Symptoms prompting an MRI were elicited by scheduled screening questionaries at each infusion or via unscheduled patient-initiated communication.

Results Of 128 urgent MRIs, 13 (10.2%) revealed new or worsening ARIA. Headache was the most common symptom prompting an urgent MRI (46.8% of urgent scans), followed by confusion (25.0%) and dizziness (10.2%), with other neurologic symptoms accounting for the remaining 18.0%. Among MRIs that detected new or worsening ARIA, headache was present in 61.5% of cases, followed by dizziness (30.7%) and confusion (7.6%). Carriership of an APOE ε4 allele was more prevalent among patients with ARIA detected on urgent MRI (84.6%) than in the overall lecanemab-treated cohort (64.1%). Urgent MRIs prompted by scheduled symptom screens yielded a threefold greater ARIA detection rate (17.8%) compared to patient-initiated calls (6.8%).

Conclusions

Urgent MRIs yielded new or worsening ARIA in 10.2% of cases and were commonly associated with headache, dizziness, and APOE ε4 carriership. Additional research is necessary to refine risk stratification and rationalize MRI utilization outside the standard monitoring protocol.

Authors/Disclosures
Kathryn Fredrickson PRESENTER	Miss Fredrickson has nothing to disclose.
Mansi Karwa, MS	Ms. Karwa has nothing to disclose.
Sokratis Charisis, MD	Dr. Charisis has nothing to disclose.
Alaina Bennett, PA	Miss Bennett has nothing to disclose.
Samantha Milano, PA	Mrs. Milano has nothing to disclose.
John Dickson, MD, PhD (Massachusetts General Hospital)	Dr. Dickson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for I-Mab Biopharma.
Liliana A. Ramirez-Gomez, MD, FAAN (Wang Ambulatory Care Center)	The institution of Dr. Ramirez-Gomez has received research support from NIA-NIH.
Kirk R. Daffner, MD, FAAN (Brigham & Women's Hospital - Harvard Medical School)	The institution of Dr. Daffner has received research support from Azheimer's Association. The institution of Dr. Daffner has received research support from FUJIFILM.
Maria Teresa Gomez-Isla, MD	No disclosure on file
Michael G. Erkkinen, MD (Brigham and Women's Hospital)	Dr. Erkkinen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen.

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