0:00

Now let's look at some clinical cases

0:02

where we can go over grading.

0:04

Uh, so what I'd like you to do is, uh,

0:07

as you're looking at this, uh, think in your mind

0:09

what you think the grade is.

0:11

So here's baseline and here's post dosing.

0:14

We see one area here of Aria E Development.

0:16

It looks like it is less than five centimeters in size.

0:20

So this is mild, it's monofocal

0:22

and it's less than five centimeters.

0:24

Here's another case. You have three areas

0:27

of involvement while post dosing.

0:29

Uh, so that would put you into the moderate category

0:33

because it's multifocal.

0:35

Uh, here's a patient at baseline and here's post dosing.

0:39

And you see here there's extensive involvement.

0:42

In fact, you might be wondering, do they have a big stroke,

0:44

which is why DWI is a required sequence for,

0:47

um, ARIA screening.

0:48

And no, this is not a stroke.

0:49

This is just shine through artifact.

0:51

So this is a severe grading here.

0:54

Uh, here's another patient. Here's the baseline

0:56

and here's post dosing.

0:58

We see a little, uh, area here of a SoCal effusion

1:02

and another little area here.

1:05

So this is moderate because, uh, it's multi, uh, uh, focal.

1:09

And so we're in the moderate category. It can't be mild.

1:12

Here's another patient here.

1:14

And we see, um,

1:16

multiple SoCal effusion here on both sides of the brain.

1:19

So this is going to be a severe Aria E case.

1:22

Um, and here is again, baseline. Here's post dosing.

1:26

We have this area of, uh, SoCal involvement.

1:29

And this is actually a mild case

1:31

because, uh, it is only involving, uh, one area

1:35

of the brain here at the end.

1:37

It is, uh, less than five centimeters in size.

1:40

Now here's another case here where it's a little bit larger.

1:43

It looks like it's probably just under 10 centimeters in

1:45

size for SoCal uh, effusion.

1:47

So this is moderate in degree. Here is a baseline.

1:50

Here's post dosing on GRE

1:53

and we see, um, some micro hemorrhage here.

1:56

And here's baseline on the flare.

1:57

And here's post dosing on the flare.

2:00

This is mild for Aria H

2:01

because there's less than, um, five foci

2:04

and it's also mild for, um, uh, aria E as well.

2:09

Now, uh, here's, uh, uh, a GRE here post dosing.

2:13

You see multiple little foci.

2:15

If you count these, these are actually,

2:17

I don't know if you can see it, but there's actually, um,

2:19

uh, five little foci here.

2:22

The number matters,

2:23

and even though it's small, you have

2:24

to count the individual a little foci.

2:26

Here's on flare where we see one area.

2:29

So this would be moderate Aria H

2:31

because we have five, uh, uh, foci here and mild for Aria E

2:36

'cause we just have one small area.

2:38

Here's another patient baseline,

2:39

and then the post dosing GRE.

2:41

We clearly have, uh, over, uh, uh, you know, uh,

2:44

10, uh, foci here.

2:46

Um, and on the baseline flare

2:49

and then the post flare,

2:50

you see an extensive area involvement.

2:51

So this is severe Aria H and severe aria E.

2:55

Uh, here's another, uh,

2:56

this was actually post dosing and this is all on the

2:58

Same patient.

3:00

Multiple little foci of micro hemorrhages.

3:01

So that's severe Aria h uh, here's another case here.

3:05

This is the baseline.

3:06

Here's post dosing where we see, uh,

3:09

superficial cirrhosis here,

3:11

and then we have, uh, two foci of micro hemorrhages.

3:14

These are actually just vessels that's not hemorrhage.

3:16

And so how would you grade this?

3:18

This is actually mild RAH,

3:20

which you might be surprised about, but it's

3:22

because we have just, uh, one focal area of, um,

3:26

superficial cirrhosis.

3:28

If you follow these down, these are all, uh,

3:29

contiguous soci,

3:31

and we just have two little dots of micro hemorrhage.

3:33

So we're mild in category for micro hemorrhage.

3:36

And what mild in category for superficial cirrhosis.

3:39

So it doesn't upgrade our call. The call stays as mild.

3:42

Uh, here is the baseline here is post dosing.

3:45

We have superficial cirrhosis here,

3:48

and a second area of superficial cirrhosis.

3:50

Again, it's important to make sure you know,

3:52

if you're in the sulcus or if you're in the brain

3:54

parenchyma, this was judged to be in the sulcus.

3:57

Uh, so it is moderate in degree

3:59

because we have two areas of superficial cirrhosis.

4:03

By the way, if this had been in the brain parenchyma,

4:06

then we would've downgraded to a mild

4:08

because, uh, we have would,

4:10

if we would've called it one micro hemorrhage

4:12

and one area of superficial cirrhosis.

4:14

But because this was judged to be in the small sulcus,

4:17

here we are in the moderate, moderate category.

4:20

Now, um, here's a baseline here, uh,

4:22

post dosing one in two months.

4:24

Again, you see it getting worse over time,

4:26

but let's try to work on what we would call the grading.

4:28

Here's the flare. Here's the GRE.

4:31

Um, we see a two foci here.

4:34

Um, some more foci here, and even more foci here.

4:37

So this is, um, uh, severe aria E at this stage here,

4:41

and then resolved Aria e, um, for the aria H We're at mild

4:45

for this one, severe for this one, and severe for this one.