Clinical Practice Recommendations of the Swiss Society for Neuroradiology: Neuroimaging Standards for Enrollment and Disease Monitoring in Anti-Amyloid Immunotherapies.

Abstract

Introduction: The Swiss Society for Neuroradiology (SSNR) has established clinical practice recommendations to guide the use of neuroimaging in the enrollment and treatment monitoring of patients undergoing anti-amyloid immunotherapies for Alzheimer's disease. In Switzerland, anti-amyloid immunotherapy (AAT) has not been approved by Swissmedic ahead of this publication. This paper therefore reflects the existing international standards of care and will be updated after market clearance of AATs in Switzerland. Background and Rationale: Neuroimaging is a key requirement to assess therapeutic responses and manage potential adverse effects, particularly amyloid-related imaging abnormalities (ARIAs). The SSNR recommendations specify the appropriate use of magnetic resonance imaging biomarkers to support therapy inclusion, routine monitoring, and decision-making in case of manifestations of ARIA-E and ARIA-H during treatment. Conclusions: This paper reviews the required imaging protocols and criteria for patient eligibility and discusses the key findings of ARIA-E and ARIA-H. These findings should be detected and interpreted by the practicing radiologist to ensure patient safety. The practice recommendations of the SSNR align with previous published recommendations of the American Society of Neuroradiology. On this basis, we also provide practical recommendations for workflows and candidate selection to continue or discontinue therapy.

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