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ARIA Clinical Decision Academy: Detection, Escalation, and System Readiness - Masterclass

Clinical radiology

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Description

This program is supported by an independent education grant from Lilly. This education program has been designed for healthcare professionals globally, excluding the UK.

Join leading Alzheimer’s disease experts Dr. Tammie L. S. Benzinger, Dr. Petrice M. Cogswell and Dr. Ana M. Franceschi, for this accredited on-demand session. Using real-world clinical vignettes and AI-enhanced imaging simulations, this masterclass explores the latest evidence-based protocols for identifying, mitigating, and managing ARIA.

Participants will gain practical insights into patient-centered risk stratification, multidisciplinary escalation pathways, and the evolving radiologic nuances essential for the safe implementation of anti-amyloid therapies in clinical practice.

Credits: AMA PRA Category 1 Credits™ (00.75.00 hours)

Prefer to read instead? Read our Key Clinical Summary here.

Session Highlights

This session uses real-world clinical vignettes to examine the newest evidence guiding ARIA detection, management, and coordinated response across multidisciplinary teams.

Examine the latest evidence-based guiding patient-centered ARIA risk discussions. Through rapid referral cases, faculty compare approaches to integrating emerging evidence-based diagnostic pathways, patient-centered goals, and eligibility considerations within contemporary shared decision-making.
Review subtle early ARIA presentations with updated radiologic and clinical insights. Explore AI-enhanced imaging simulations and serial MRI studies, with faculty discussing inter-reader variability, current interpretation nuances, and how evolving evidence informs precise grading thresholds.
Explore current strategies for ARIA risk mitigation across diverse clinical scenarios. Using real-time simulations, faculty discuss evidence-informed approaches to dose adjustment, risk-stratification, and monitoring intervals as reflected in the newest guidance and clinical trial data.
Discuss multidisciplinary ARIA escalation pathways shaped by emerging data. Walk through high-stakes "STAT" MRI scenarios from the Emergency Department to radiology and neurology coordination, highlighting structured reporting language, closed-loop communication practices, and system-level readiness benchmarks

Who Should Attend?

This program is designed for healthcare professionals involved in Alzheimer’s disease diagnosis, imaging, treatment, and acute evaluation, including:

Neuroradiologists and Radiologists (MD/DO)
Neurologists specializing in cognitive disorders
Dementia Specialists (MD/DO/NP/PA)
Geriatricians
Emergency Medicine Physicians and acute evaluation teams
Nurse Practitioners and Physician Assistants
MDT Healthcare Professionals involved in ARIA monitoring
Neuroradiology and Radiology Fellows and Trainees

Faculty

Tammie L. S. Benzinger, MD, PhD, is the Hugh Monroe Wilson Professor of Radiology and Chief of MRI Service at the Mallinckrodt Institute of Radiology at Washington University School of Medicine. Her work focuses on PET and MRI biomarkers for Alzheimer’s disease and related neurodegenerative disorders, and she directs imaging programs for the Knight Alzheimer’s Disease Research Center, DIAN, and DIAN-TU. A recognized leader in neuroradiology, she has received multiple national awards and is known for advancing early detection of degenerative brain disease through innovative imaging science.

Petrice M. Cogswell, MD, PhD, is an Associate Professor of Radiology and Consultant in the Division of Neuroradiology at Mayo Clinic, Rochester. A leading expert in advanced neuroimaging, her research focuses on the intersection of quantitative MRI, machine learning, and biomarker modeling to enhance the diagnosis of neurodegenerative disorders. Dr. Cogswell is a prominent figure in the field of Alzheimer’s disease, currently serving as Vice Chair of the ARIA and Dementia Study Group for the American Society of Neuroradiology and as a member of the AHA Amyloid-Related Imaging Abnormalities Summit Planning Committee. Her work is instrumental in developing the imaging protocols and clinical workflows used to detect and monitor ARIA in patients receiving anti-amyloid immunotherapies. Dr. Cogswell also serves as a Co-Investigator for several NIH-funded initiatives, including the Alzheimer’s Clinical Trials Consortium (ACTC) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI), dedicated to advancing safe, personalized care through innovative imaging science.

Ana M. Franceschi, MD, PhD is an Associate Professor of Radiology at the Zucker School of Medicine at Hofstra/Northwell and a leading neuroradiologist at Northwell Health. Her work specializes in neurological molecular imaging, with a distinguished focus on the advancement of brain PET/MRI and hybrid imaging techniques to combat dementia and neurodegenerative disease. A prolific researcher, she was awarded the Foundation of the ASNR Boerger Research Fund for Alzheimer’s Disease and Neurocognitive Disorders to study abnormal tau accumulation in Primary Progressive Aphasia (PPA) and currently serves as Principal Investigator on studies seeking universal biomarkers for the A/T/N classification of dementia.

Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from Lilly.

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

Disclosures

Tammie Benzinger, MD, PhD has disclosed financial interests or relationships within the past 24 months with the following ineligible companies: Research Support / Grants: NIH/NIA, Alzheimer’s Association, GHR Foundation, Anonymous Foundation, Dominantly Inherited Alzheimer Network (DIAN) Trials Unit (TU) Pharma Consortium, Hope Center for Neurological Disorders, Barnes-Jewish Hospital Foundation, NIH-AMP, American Society for Neuroradiology, Eli Lily/Avid Radiopharmaceuticals, LMI/Lantheus, Siemens, Hyperfine; Clinical Trials (Investigator): Eli Lilly, Roche, Biogen, J&J, Eisai; Consulting/Advisory Board: Biogen, Eisai, Lilly, Bristol Myers, J&J, Merck, Siemens; Travel: J&J, Eisai. Dr. Benzinger intends to discuss non-FDA uses of drug products and/or devices only in relation to products for which she has no financial relationships. She will disclose to the audience when this discussion takes place.

Petrice M. Cogswell, MD, PhD, has disclosed financial interests or relationships within the past 24 months with the following ineligible companies: Honoraria: Eisai. Dr Cogswell participates in the Data and Safety Monitoring Board for Eisai and Lilly (with no financial compensation). Dr Cogswell does not intend to reference unlabeled or unapproved uses of drugs or products.

Ana M. Franceschi, MD, PhD, has disclosed financial interests or relationships within the past 24 months with the following ineligible companies: Advisory Board: Biogen, Eli Lilly, Roche/Genentech, Icometrix, Cortechs ai; Consultant: Biogen, Eisai, Eli Lilly, Roche/Genentech, Siemens Healthineers, Life Molecular Imaging/Lantheus, Blue Earth Diagnostics, MIM Software, Icometrix, Cortechs ai, PeerView, Medical Learning Institute, Springer Nature, Medscape, Med Learning Group. Dr Franceschi does not intend to reference unlabeled or unapproved uses of drugs or products.

These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. All relevant financial relationships for anyone associated with the content of this activity were mitigated prior to the release of this program.

Activity Accreditation for Health Professions

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physician Assistants

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

Participation Costs

There is no additional cost to participate in this program.

This continuing education activity is active starting May 27th 2026, and will expire on May 19th 2027.

Estimated time to complete this activity: 45 minutes.

Learning objectives

Accurately use and interpret neuroimaging modalities within evidence-based diagnostic pathways to proactively identify patients with early symptomatic AD.
Apply evidence-based neuroradiological management protocols to confidently recognize, diagnose, and manage ARIA, incorporating risk-stratification and management protocols.
Utilize rapid, closed-loop communication and escalation with the AD multidisciplinary team - particularly in the emergency setting - using standardized ARIA reporting.
Integrate emerging data and guidelines regarding ARIA risk, risk minimization strategies, and monitoring into clinical and neuroradiology workflows.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Well, good morning, everyone. We're so happy to have you here with us. To start off, we'll be discussing PET imaging, so molecular neuroimaging, specifically on the diagnosis of early Alzheimer's disease. So as most of you are aware, we've shifted in practice from a clinical or a phenotypical diagnosis to a biological biomarker-based diagnosis of Alzheimer's disease and related neurocognitive disorders. We start with the accumulation of amyloid beta, specifically amyloid beta 42, which serves as a core one biomarker, meaning the earlier stage that we can detect in vivo. Meanwhile, tau neurofibil tangles occur later on in the pathophysiologic cascade. They drive neurodegeneration, and tau tends to spread in a predictive, stepwise pattern, which means that as a core to biomarkers, it allows us for assessment of biological disease severity and disease staging. And so this curve that you see on the right is the famous Jack curve. What it highlights is the various Alzheimer's disease biomarkers, be it fluids, so CSF or plasma, or imaging, and their correlation with clinical disease stages. And what you can note here is that many of these biomarkers become abnormal far earlier than clinical symptom onset. So typically for amyloid PET, it can be abnormal even 2 to 3 decades before clinical symptoms begin. Now in clinical practice, what we have available is amyloid tau and also FDG PET, and all three have value in the clinical workup of Alzheimer's disease. Typically, amyloid PET is also the main scan we use to triage patients for anti-amyloid therapy. Tau is a Attained in order to assess biological disease severity and predict treatment response. And finally, MDG PET is really important in the differential diagnosis of neurodegenerative disease, particularly in the many patients with co-pathologies in the setting of mixed dementia. So, let's move on to our first case. This is an 80 year old female with memory loss. This is an amyloid PET scan. What you see here are 3 millimeter cuts from the vertex to the skull base. And just remember for amyloid PET imaging, we use the cerebellum as a reference region. So in this case, you can see that in contrast to the cerebellum, in the stentorial compartment, we have diffuse accumulation of the radio tracer throughout the neocortex, and so visually this case does indeed look positive. We move on to quantification and you can see that this case has a quantification score in the 70s and then the corresponding SUVR values as well, including both global and regional SUVRs. So this brings us to our first polling question, and the question is which of the following features of AMOLI PET imaging findings supports a diagnosis of Alzheimer's disease in this patient, and please choose the best answer. Alright, fantastic. So over 70% of you did select the correct answer visual reinterpretation of amyloid uptake supported by quantification. So just remember the FDA labels for the 3 amyloid PET radiopharmaceuticals on the market in the US were updated last June to add quantification. As an adjunct to visual read, you know, furthermore, quantification metrics, specifically the centroid score, were used as a secondary outcome measure in the phase 3 clinical trials of both like a nebub and Donnaebub. So they have been definitively integrated into clinical practice. So with that, when we think about the amyloid quantification, I think most of us really do focus on the scentilloid scales for several reasons, including, as I mentioned, it was one of the secondary outcome measures for the phase 3 clinical trials of both drugs on the market. The centralloid scale was created almost a decade ago in the research setting in order to standardize comparisons of scans from different institutions obtained with different protocols and different scanners and with different radio tracers. It's essentially an unbounded scale with two anchor points, a scentoid of zero, which is it. Indicative of a scentyloid level or amyloid level in normal healthy controls and a scentilloid of 100, which is indicative of the amyloid level in a typical patient with mild to moderate Alzheimer's disease pathology. So you see here in the graphics some key cutoff points. So some numbers to keep in mind are sentloid score less than 10, which essentially rules out Alzheimer's disease. Indicates also that beta amyloid plaques are completely absent as well as a score greater than 30, which typically indicates established beta amyloid pathology. Keep in mind that the mean centoloid value of the patients that were enrolled in clinical trials for the two therapeutics on the market were in the range of 75 to 95. And of course any discrepancy between the. Visual read and the sentiid values should then be reported in your reports with a rationale for the final report decision. Thank you. We're going to move on to another case. This is a 72-year-old male presenting with a progressive aphasic dementia. The patient is a neurosurgeon no longer able to see patients based on their exam, has a mild to moderate dementia syndrome. They had an amyloid PET first performed and the amyloid PET is a florbetape, and it shows regions of cortical amyloid deposition, resulting in blurring of the gray-white junction. This is greatest in the frontal lobes, asymmetric on the left, greater than right, and the enyloid value is 42. So another polling question, is this amyloid PET positive? Correct, so this amyloid PET is positive. There are multiple regions, though patchy regions of blurring of that gray-white junction indicative of cortical amyloid deposition, and the enyloid value of 42 supports the positive visual read. Next, the patient had an FDG PET performed, and this again is to help determine the etiology of the patient's syndrome. So there was a question based on the presentation, whether this is Alzheimer's disease or frontotemporal frontal temporal lobar degeneration. The FDG PEET shows left greater than right temporal and parietal hypometabolism. This is suggestive of underlying Alzheimer's disease and in a pattern of leukopenic primary progressive aphasia. There's also relatively extensive hypometabolism in other regions including the frontal lobes as well as occipital lobes, and based on the patient's clinical presentation, as well as the FDG PET and a relatively low amyloid level for their degree of clinical impairment, the patient went on to have a tau PET to help discern if it was Alzheimer's disease leading to their dementia. And here the taupet shows extensive neocortical tau deposition involving the temporal parietal as well as frontal lobes. So this is a moderate to advanced tau burden. So in this case, the integration of multiple modes of PET imaging, as well as the clinical features were important in their differential diagnosis. So this patient has a diagnosis of Alzheimer's disease with a logopenic primary progressive aphasia subtype. And the amyloid tau and FDG PET again were all helpful in that the amyloid PET says there is AD pathology here, but again the the amyloid loads was relatively lower than expected and the tau PET here confirmed that Alzheimer's disease was the driver of their clinical syndrome. The taupet also informs prognosis, as was mentioned, as a patient with this high of a tau load is expected to benefit less from amyloid targeting therapies than someone with a low tau load at initiation of therapy. Thank you, Patrice. You know these are complicated patients, and I'm, I'm thinking a lot of people in our audience may only read the brain MRI, and it's so important. I think to understand that in the context of the amyloid PET, the tau PET, the FDG, and other testing, I can't tell you, um, how many times I get a call to overread someone else's brain MRI findings because they ignored the PET results. So just like when we're in reading an oncology study, right, if you're doing a head and neck case, you don't ignore the FTG PET. I think it's really important that all the radiologists understand that these PET scans, even if they're not interpreting them. And then the other thing is these patients that we're showing you, these are our actual cases, and they're, they're not squeaky clean like they were in clinical trials. So every case it seems like has some complicating thing to think about. So this is a patient of ours that was a slowly progressive cognitive decline and you know like Doctor Cogswell's case, it's a primarily a word finding problem and substituting random words, um, losing skills, not cooking or driving. Um, and some remote cancer histories and so, um, um, so the diagnosis this person also had was a, a variant of primary progressive aphasia. They had in our, in this case CSF for their amyloid testing, so you can test for the amyloid with a PET scan. Um, in the past it was more frequently done with lumbar puncture, but now that PET's reimbursed, we're all seeing a lot more amyloid PET as well. And then they also tell us the APOE status. So all of you are familiar with APOE as a risk for C.