A European perspective on ARIA monitoring in clinical practice

03/03/2026, Wim Van Hecke - CEO icometrix

A new era in Alzheimer’s disease care

When disease-modifying therapies transformed multiple sclerosis care, brain MRI scans became central to annual patient monitoring. Standardized MRI protocols and clinical guidelines emerged. Teams adapted. Technology helped scale expertise and consistency.

Today, Alzheimer’s disease is entering a similar transformative era, with amyloid-targeting therapies being approved in many countries across the globe. To benefit from the therapies’ positive impact on cognitive decline and quality of life, a timely diagnosis and careful monitoring of amyloid-related imaging abnormalities (ARIA) are essential. Once again, serial brain MRI scans have a pivotal role. As we have learned from the field of multiple sclerosis, standardized MRI protocols, optimized (imaging) workflows, AI-supported quantified reading, and practical education about the clinical and treatment guidelines are critical enablers of safe, scalable treatment delivery.

Therapeutic progress drives diagnostic transformation. Is the field of Alzheimer’s care ready for the same transformative leap as multiple sclerosis, but at a vastly larger scale?

Several continents, different paces

Since the regulatory clearances of anti-amyloid therapies in the U.S., healthcare systems have been addressing the practical challenges related to the implementation:

• introducing new workflows,

• standardizing MRI acquisition,

• establishing consistent protocols for timely diagnosis and ARIA detection, quantification, and grading, with many including icobrain as a key component.

In Europe, approvals by the European Medical Association came later, in April 2025. However, in this fragmented European healthcare market, systemic challenges such as country-specific reimbursement/adoption pathways restrict the fast adoption of amyloid-targeting therapies today. European healthcare systems also have to get ready to implement new workflows for people with Alzheimer’s disease.

A recently published pan-European survey provides critical insights into current capabilities, gaps, and clinical readiness for delivering anti-amyloid therapies at scale (1).

A European readiness perspective

Led by the ESNR/EAN ARIA Working Group, and authored by Tiago Gil Oliveira, Meike Vernooij, Giovanni Frisoni, Roland Wiest, and Frederik Barkhof, the survey, distributed across 41 countries, gathered responses from over 400 clinicians - nearly evenly split between neurologists and (neuro)radiologists, with a strong presence from academic centers (58%).

Recognition of ARIA is growing among clinicians, but familiarity still varies:

• ~30% of respondents (including nearly one-third of neuroradiologists) were unfamiliar with ARIA altogether

• ~38% of neurologists were not familiar with the key risk factors for ARIA

These findings highlight an opportunity for broader education to support further consistency amongst clinicians when ARIA management becomes part of routine care.

There’s growing confidence in detecting ARIA on MRI, particularly among neuroradiologists:

• 83% felt confident identifying ARIA-H

• 70% felt confident identifying ARIA-E

Higher confidence in ARIA-H likely reflects its more distinct imaging features. ARIA-E, with its diffuse and variable presentation, remains more challenging - underscoring the need for targeted training and supportive tools.

However, only 12% of neuroradiologists reported being very confident in grading ARIA severity, which is a crucial decision-making bottleneck. ARIA grading directly informs whether treatment is continued, paused, or discontinued. 

Many institutions are still building the foundation needed for ARIA monitoring:

• 82% of respondents reported not having implemented dedicated MRI protocol for ARIA

• 34% said their institutions were poorly equipped to meet the expected demands

These findings highlight clear opportunities for alignment through shared learning, best practices, and collaborative progress across institutions.

A(I) path forward

With ARIA monitoring becoming part of routine care, 72% of European clinicians rated AI support as valuable for the detection and grading of all these monitoring MRI scans (1). This is why we developed icobrain aria, currently the only FDA-cleared solution for the detection, quantification, and grading of ARIA. It provides structured, objective insights that support clinical judgment and help translate evolving protocols into consistent daily practice.

Further, 93% of respondents expressed a desire for further training. Fortunately, platforms like ariaeducation.eu, alzimaging.org, and understandingaria.com are already stepping in to close the gap between clinical guidance and real-world practice.

The takeaway

The ESNR/EAN ARIA Working Group survey is a call to action for everyone involved in European Alzheimer’s care: neurologists, radiologists, hospital leaders, and policymakers. The therapies are coming. The patient's need is huge. And the healthcare infrastructure must catch up.

We are committed to continuing our strong dedication to training, standardized imaging protocols, and the thoughtful adoption of AI technology to help close the gaps clinicians face today - while also learning from peers who are further along, including colleagues in the U.S.

Regulatory approval is not the endpoint; it’s the starting line to impact patient care.

(1) Oliveira TG, Vernooij MW, Frisoni GB, Wiest R, Barkhof F. Are we ready for amyloid-related imaging abnormalities (ARIA) monitoring? A European survey among neuroradiologists and neurologists by the ESNR/EAN Working Group. Eur Radiol 2026. DOI: 10.1007/s00330-025-12214-8.